Provider Demographics
NPI:1013900547
Name:CROSS, GREGORY H II (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:H
Last Name:CROSS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1829
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83816-1829
Mailing Address - Country:US
Mailing Address - Phone:800-667-9334
Mailing Address - Fax:208-664-2341
Practice Address - Street 1:707 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3409
Practice Address - Country:US
Practice Address - Phone:307-578-2582
Practice Address - Fax:307-578-2389
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY6294A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY117711700Medicaid
WYP00199154OtherRR MEDICARE
WY117711700Medicaid
H72879Medicare UPIN