Provider Demographics
NPI:1700864451
Name:CROSBY, TOMMYE ROYCE (MD)
Entity Type:Individual
Prefix:
First Name:TOMMYE
Middle Name:ROYCE
Last Name:CROSBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 S HIGHWAY 29
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-8508
Mailing Address - Country:US
Mailing Address - Phone:850-968-2083
Mailing Address - Fax:850-968-6024
Practice Address - Street 1:2360 S HIGHWAY 29
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-8508
Practice Address - Country:US
Practice Address - Phone:850-968-2083
Practice Address - Fax:850-968-6024
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN-6953207Q00000X
FLME115498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100129110BMedicaid
OK100747570AMedicaid
MO207863911Medicaid
C68094Medicare UPIN
AR5AB77B608Medicare PIN
OK100747570AMedicaid
4513920002Medicare NSC
400522488Medicare PIN
OK100129110BMedicaid
DC3959Medicare PIN