Provider Demographics
NPI:1821177486
Name:CROSIER, JESS (MD)
Entity Type:Individual
Prefix:DR
First Name:JESS
Middle Name:
Last Name:CROSIER
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 52545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2545
Mailing Address - Country:US
Mailing Address - Phone:337-234-3659
Mailing Address - Fax:337-232-6962
Practice Address - Street 1:611 SAINT LANDRY ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4627
Practice Address - Country:US
Practice Address - Phone:337-234-3659
Practice Address - Fax:337-232-6962
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08738R207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1661601Medicaid
G06534Medicare UPIN
LA5W229CB98Medicare PIN