Provider Demographics
NPI:1376553453
Name:CROSS, HOWARD PAUL JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:PAUL
Last Name:CROSS
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108546 S 4776 RD
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:OK
Mailing Address - Zip Code:74954-5140
Mailing Address - Country:US
Mailing Address - Phone:918-427-5242
Mailing Address - Fax:
Practice Address - Street 1:108546 S 4776 RD
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:OK
Practice Address - Zip Code:74954-5140
Practice Address - Country:US
Practice Address - Phone:918-427-5242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC00327367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100784790AMedicaid
AR112992001Medicaid
KS200606650AMedicaid
AR112992001Medicaid
OK100784790AMedicaid