Provider Demographics
NPI:1265529200
Name:CROZIER, GORDON JOHNSON (DO)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:JOHNSON
Last Name:CROZIER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 S INTERNATIONAL PKWY
Mailing Address - Street 2:2071
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1413
Mailing Address - Country:US
Mailing Address - Phone:606-776-7707
Mailing Address - Fax:407-732-7669
Practice Address - Street 1:1307 S INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 2071
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1413
Practice Address - Country:US
Practice Address - Phone:606-776-7707
Practice Address - Fax:407-732-7669
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS115102083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDO0000001336OtherLICENSE
TN582636039OtherTAX ID
TNBC4712457OtherDEA
TN16BDVDBOtherMCR
TN582636039OtherTAX ID
TNBC4712457OtherDEA
TNDO0000001336OtherLICENSE
TN3319222Medicare ID - Type Unspecified