Provider Demographics
NPI:1538197579
Name:CROLEY, WILLIAM CHRISTOPHER
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHRISTOPHER
Last Name:CROLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-5935
Mailing Address - Country:US
Mailing Address - Phone:850-477-7042
Mailing Address - Fax:850-474-9060
Practice Address - Street 1:4901 GRANDE DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-5935
Practice Address - Country:US
Practice Address - Phone:850-477-7042
Practice Address - Fax:850-474-9060
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336074675207L00000X
IL036-112974207LC0200X
FLME110671207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14FZ1OtherBLUE CROSS BLUE SHIELD
FL004095900Medicaid
IL036112974Medicaid
AL131506Medicaid
IL01615142OtherBCBS PROVIDER NUMBER
AL131839Medicaid
AL131839Medicaid
FLFK855ZMedicare PIN
IL363117700OtherGROUP TAX ID NUMBER