Provider Demographics
NPI:1205872587
Name:CROSS, JEFFREY SCHUYLER (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCHUYLER
Last Name:CROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 W. 2ND PL
Mailing Address - Street 2:SUITE #210
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228
Mailing Address - Country:US
Mailing Address - Phone:720-321-8080
Mailing Address - Fax:720-321-8081
Practice Address - Street 1:2460 W 26TH AVE
Practice Address - Street 2:SUITE 420-C
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5308
Practice Address - Country:US
Practice Address - Phone:303-480-3565
Practice Address - Fax:303-480-3566
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31856208600000X
KS0425424208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY117084800Medicaid
CO01318567Medicaid
KS100166590AMedicaid
KS047510Medicare ID - Type Unspecified
COF95851Medicare UPIN
CO01318567Medicaid
KS100166590AMedicaid