Provider Demographics
NPI:1942349964
Name:CROSS, JENNETTE L (MD)
Entity Type:Individual
Prefix:
First Name:JENNETTE
Middle Name:L
Last Name:CROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 CALIFORNIA ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-5424
Mailing Address - Country:US
Mailing Address - Phone:800-997-6196
Mailing Address - Fax:415-504-1367
Practice Address - Street 1:1 CALIFORNIA ST STE 2300
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-5424
Practice Address - Country:US
Practice Address - Phone:800-997-6196
Practice Address - Fax:415-504-1367
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-39424207Q00000X
MO2016034911207Q00000X
UT9903554-1205207Q00000X
WI66300-20207Q00000X
IL036141614207Q00000X
OK32563207Q00000X
IAMD-43792207Q00000X
CODR.0056894207Q00000X
ALMD.35469207Q00000X
NE29599207Q00000X
TXM7925207Q00000X
MN61274207Q00000X
SD10159207Q00000X
MS24689207Q00000X
ND14395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192991103Medicaid
TXP00702266Medicare PIN
TXTXB108847Medicare PIN
TX8K5939Medicare PIN