Provider Demographics
NPI:1255739595
Name:CROSBY, LELAND WILSON (PA, MED)
Entity type:Individual
Prefix:MR
First Name:LELAND
Middle Name:WILSON
Last Name:CROSBY
Suffix:
Gender:M
Credentials:PA, MED
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2350 ATASCOCITA RD
Mailing Address - Street 2:PAM LYCHNER STATE JAIL
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-3503
Mailing Address - Country:US
Mailing Address - Phone:281-454-5036
Mailing Address - Fax:
Practice Address - Street 1:2350 ATASCOCITA RD
Practice Address - Street 2:PAM LYCHNER STATE JAIL
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-3503
Practice Address - Country:US
Practice Address - Phone:281-454-5036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA00673363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant