Provider Demographics
NPI:1255607735
Name:CROSS, CAROLINE L (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:L
Last Name:CROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85007-2908
Mailing Address - Country:US
Mailing Address - Phone:480-227-4227
Mailing Address - Fax:
Practice Address - Street 1:701 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-2908
Practice Address - Country:US
Practice Address - Phone:480-227-4227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ49844173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program