Provider Demographics
NPI:1760108583
Name:CROLEY, GARY LEE JR
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LEE
Last Name:CROLEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 HOCKING MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:OH
Mailing Address - Zip Code:45050-1902
Mailing Address - Country:US
Mailing Address - Phone:513-991-7433
Mailing Address - Fax:
Practice Address - Street 1:857 HOCKING MEADOW CIR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:OH
Practice Address - Zip Code:45050-1902
Practice Address - Country:US
Practice Address - Phone:513-991-7433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)