Provider Demographics
NPI:1982604948
Name:CROSBY, SIDNEY S (MD)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:S
Last Name:CROSBY
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 639
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:AL
Mailing Address - Zip Code:36545-0639
Mailing Address - Country:US
Mailing Address - Phone:251-246-4446
Mailing Address - Fax:251-246-5111
Practice Address - Street 1:227 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:AL
Practice Address - Zip Code:36545-2423
Practice Address - Country:US
Practice Address - Phone:251-246-4446
Practice Address - Fax:251-246-5111
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2009-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL541392602Medicaid
AL1750393682Medicaid
AL1982604948Medicaid
AL1750393682OtherGROUP NPI #
AL37556OtherMEDICARE PROVIDER #
AL529700760Medicaid
AL051037556Medicaid
AL541003926Medicaid
ALF712OtherMEDICARE GROUP ID
AL1982604948Medicaid
AL529700760Medicaid