Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 00001222 | WA |
Y | 207X00000X | Orthopaedic Surgeon | OP00001222 | WA |
NPI | 1144262163 |
---|---|
Provider Name | Dr. Thomas L Cross |
First Address | Federal Way, WA 98003-8723 |
Second Address | Federal Way, WA 98003-8723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 23/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0219677 | STATE L&I (01) | WA |
1052596 | (05) | WA |
E16461 | (02) | WA |