Provider Demographics
NPI:1710978499
Name:CROSBY, WILLIAM MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MICHAEL
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:PO BOX 82298
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-2298
Mailing Address - Country:US
Mailing Address - Phone:337-288-4895
Mailing Address - Fax:307-206-1214
Practice Address - Street 1:535 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3410
Practice Address - Country:US
Practice Address - Phone:307-206-1224
Practice Address - Fax:307-206-1214
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4201A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY120134400Medicaid
WY20021Medicare ID - Type Unspecified