Provider Demographics
NPI:1558549634
Name:CROSS, ALISA (MD)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:
Other - Last Name:MELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 STANTON L YOUNG BLVD # 9000
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5018
Mailing Address - Country:US
Mailing Address - Phone:405-271-5781
Mailing Address - Fax:405-271-3919
Practice Address - Street 1:800 STANTON L YOUNG BLVD # 9000
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5018
Practice Address - Country:US
Practice Address - Phone:405-271-5781
Practice Address - Fax:405-271-3919
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31186208600000X
GA00-2040208600000X
PAMD4478642086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028277250001Medicaid
299180NJ8Medicare PIN