Provider Demographics
NPI:1760445241
Name:CROSBY, GLENN ALLEN II (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ALLEN
Last Name:CROSBY
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GLENN
Other - Middle Name:ALLEN
Other - Last Name:CROSBY
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6027 WALNUT GROVE RD
Mailing Address - Street 2:SUITE 409
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2145
Mailing Address - Country:US
Mailing Address - Phone:901-683-4594
Mailing Address - Fax:901-683-0623
Practice Address - Street 1:6027 WALNUT GROVE RD
Practice Address - Street 2:SUITE 409
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2145
Practice Address - Country:US
Practice Address - Phone:901-683-4594
Practice Address - Fax:901-683-0623
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27889207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00048606OtherRR MEDICARE
TN4055530OtherBC PROVIDER NUMBER
TNP00022990OtherRR MEDICARE
MS140000157Medicare ID - Type UnspecifiedPROVIDER NUMBER
TNP00022990OtherRR MEDICARE
MSP00048606OtherRR MEDICARE