Basic Information
| Provider Information | |||||||||
| NPI: | 1205921699 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROSSLEY | ||||||||
| FirstName: | MARGOT | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6965 TUTT BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809233597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192665944 | ||||||||
| FaxNumber: | 7192665947 | ||||||||
| Practice Location | |||||||||
| Address1: | 6965 TUTT BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809233597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192665944 | ||||||||
| FaxNumber: | 7192665947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 03/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 34758 | CO | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 01347582 | 05 | CO | MEDICAID | BW6340979 | 01 | CO | DEA | OTHER |