Provider Demographics
NPI:1215938501
Name:CROSBY, RAYMOND DERRY (DO)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:DERRY
Last Name:CROSBY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2310 N PATTERSON ST
Mailing Address - Street 2:BLDG D
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2568
Mailing Address - Country:US
Mailing Address - Phone:229-247-2482
Mailing Address - Fax:229-247-0827
Practice Address - Street 1:2310 N PATTERSON ST
Practice Address - Street 2:BLDG D
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2568
Practice Address - Country:US
Practice Address - Phone:229-247-2482
Practice Address - Fax:229-247-0827
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA29316207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D45150Medicare UPIN
GAGRP 108Medicare ID - Type Unspecified