Provider Demographics
NPI:1689029613
Name:CROSS, PERCY
Entity Type:Individual
Prefix:
First Name:PERCY
Middle Name:
Last Name:CROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 ELKERTON AVE APT 314
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1579
Mailing Address - Country:US
Mailing Address - Phone:269-216-3206
Mailing Address - Fax:
Practice Address - Street 1:2007 ELKERTON AVE APT 314
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1579
Practice Address - Country:US
Practice Address - Phone:269-216-3206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other