Provider Demographics
NPI:1962404228
Name:CROSIER, JEFFERSON WARD (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFERSON
Middle Name:WARD
Last Name:CROSIER
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 1:753 HUMBLE DR
Mailing Address - Street 2:STE B
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4202
Mailing Address - Country:US
Mailing Address - Phone:931-520-1800
Mailing Address - Fax:931-520-1844
Practice Address - Street 1:753 HUMBLE DR
Practice Address - Street 2:STE B
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4202
Practice Address - Country:US
Practice Address - Phone:931-520-1800
Practice Address - Fax:931-520-1844
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0008019174400000X
TNMD8019174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1508364Medicaid
TNB02843Medicare UPIN
B02843Medicare UPIN
TN1508364Medicaid