Provider Demographics
NPI:1700346228
Name:CROSSER, BRIAN DANIEL (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:DANIEL
Last Name:CROSSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 2ND AVE STE C1
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1791
Mailing Address - Country:US
Mailing Address - Phone:270-780-2690
Mailing Address - Fax:
Practice Address - Street 1:825 2ND AVE STE C1
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1791
Practice Address - Country:US
Practice Address - Phone:270-780-2690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY59271208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY59271OtherLICENSE
KY7100684390Medicaid