Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 23727 | TN |
N | 208000000X | Pediatrician | 23727 | TN |
NPI | 1417933276 |
---|---|
Provider Name | Dr. Cynthia Denise Cross |
First Address | Collierville, TN 38017-7377 |
Second Address | Memphis, TN 38132-2113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 24/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F75717 | (02) | TN |