Provider Demographics
NPI:1922090315
Name:CROSS, BRUCE A (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:CROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11449
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4005
Mailing Address - Country:US
Mailing Address - Phone:479-709-1924
Mailing Address - Fax:479-709-7499
Practice Address - Street 1:1502 DODSON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-5128
Practice Address - Country:US
Practice Address - Phone:479-709-7190
Practice Address - Fax:479-709-7193
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0567202085R0001X
ARE71782085R0001X
KS04317742085R0001X
TXH48932085R0203X
MO364692085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR189668001Medicaid
OH0301409Medicaid
KS200381370AMedicaid
OK200078430AMedicaid
KSA12633Medicare UPIN
AR5AM45Medicare PIN