Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | E8507 | AR |
NPI | 1013170596 |
---|---|
Provider Name | Christopher Brian Cross |
First Address | Fort Smith, AR 72903-4067 |
Second Address | Fort Smith, AR 72903-4067 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2008 |
Last Update Date | 28/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200533550A | OKLAHOMA MEDICAID (01) | OK |