Provider Demographics
NPI:1568462554
Name:CROSSNO, RONALD JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAY
Last Name:CROSSNO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1904 SAGER RD
Mailing Address - Street 2:
Mailing Address - City:ROCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76567-2058
Mailing Address - Country:US
Mailing Address - Phone:512-417-8497
Mailing Address - Fax:888-656-2446
Practice Address - Street 1:2626B S 37TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7136
Practice Address - Country:US
Practice Address - Phone:254-742-2000
Practice Address - Fax:888-656-2446
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-31
Last Update Date:2010-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF9338207QG0300X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC14909Medicare UPIN