Provider Demographics
NPI:1407227424
Name:CROSS, JEREMY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:CROSS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 ILLAHEE RD NE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-8312
Mailing Address - Country:US
Mailing Address - Phone:360-616-9563
Mailing Address - Fax:360-850-1423
Practice Address - Street 1:9399 RIDGETOP BLVD NW STE A
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8505
Practice Address - Country:US
Practice Address - Phone:360-900-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60951930213E00000X
WAPO60951930213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist