Provider Demographics
NPI:1922299171
Name:EARL J CROSSWRIGHT MD PA
Entity Type:Organization
Organization Name:EARL J CROSSWRIGHT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CROSSWRIGHT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:850-712-5000
Mailing Address - Street 1:841 W MALLORY ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-6321
Mailing Address - Country:US
Mailing Address - Phone:850-332-6704
Mailing Address - Fax:888-793-0432
Practice Address - Street 1:841 W MALLORY ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6321
Practice Address - Country:US
Practice Address - Phone:850-332-6704
Practice Address - Fax:888-793-0432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF9635OtherMEDICARE RAILROAD
FL008L1OtherBLUE CROSS BLUE SHIELD OF FLORIDA
FL004285200Medicaid
FL004285200Medicaid