Provider Demographics
NPI:1285606756
Name:CROSSLEY, DAVID W (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:W
Last Name:CROSSLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 15TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5240
Mailing Address - Country:US
Mailing Address - Phone:406-454-2171
Mailing Address - Fax:406-771-3012
Practice Address - Street 1:3000 15TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5240
Practice Address - Country:US
Practice Address - Phone:406-454-2171
Practice Address - Fax:406-771-3012
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT185363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000092033OtherBLUE CROSS BLUE SHIELD
970005612OtherMEDICARE RAILROAD
MT1285606756Medicaid
MTR58119Medicare UPIN
MT000092033OtherBLUE CROSS BLUE SHIELD