1831548965 NPI number — OMONMEN O CROSSLEY M.D.

Table of content: OMONMEN O CROSSLEY M.D. (NPI 1831548965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831548965 NPI number — OMONMEN O CROSSLEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROSSLEY
Provider First Name:
OMONMEN
Provider Middle Name:
O
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CROSSLEY
Provider Other First Name:
OMON
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1831548965
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
294 UPTOWN BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR HILL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75104-3537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-817-6300
Provider Business Mailing Address Fax Number:
972-817-6310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
294 UPTOWN BLVD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR HILL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-293-3569
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  R5743 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)