Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | F9338 | TX |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | F9338 | TX |
NPI | 1568462554 |
---|---|
Provider Name | Dr. Ronald Jay Crossno |
First Address | Rockdale, TX 76567-2058 |
Second Address | Temple, TX 76504-7136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2005 |
Last Update Date | 13/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C14909 | (02) | TX |