Basic Information
| Provider Information | |||||||||
| NPI: | 1538197579 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROLEY | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4901 GRANDE DR | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325045935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504777042 | ||||||||
| FaxNumber: | 8504749060 | ||||||||
| Practice Location | |||||||||
| Address1: | 4901 GRANDE DR | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325045935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504777042 | ||||||||
| FaxNumber: | 8504749060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 11/29/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 336074675 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LC0200X | 036-112974 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine | 207LC0200X | ME110671 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 14FZ1 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 004095900 | 05 | FL | MEDICAID | 036112974 | 05 | IL | MEDICAID | 131506 | 05 | AL | MEDICAID | 01615142 | 01 | IL | BCBS PROVIDER NUMBER | OTHER | 131839 | 05 | AL | MEDICAID |