Provider Demographics
NPI:1366584005
Name:POWEL A CROSLEY MD PL
Entity type:Organization
Organization Name:POWEL A CROSLEY MD PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:POWEL
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:CROSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-485-1890
Mailing Address - Street 1:389 COMMERCIAL COURT
Mailing Address - Street 2:SUITE B
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-1617
Mailing Address - Country:US
Mailing Address - Phone:941-485-1890
Mailing Address - Fax:941-485-1873
Practice Address - Street 1:389 COMMERCIAL COURT
Practice Address - Street 2:SUITE B
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1617
Practice Address - Country:US
Practice Address - Phone:941-485-1890
Practice Address - Fax:941-485-1873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 91876208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID