Provider Demographics
NPI:1336146927
Name:CROSS, JONATHAN S (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:S
Last Name:CROSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9960 NW 116TH WAY STE 13
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1175
Mailing Address - Country:US
Mailing Address - Phone:786-924-1311
Mailing Address - Fax:786-924-1313
Practice Address - Street 1:21000 NE 28TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1402
Practice Address - Country:US
Practice Address - Phone:305-933-5993
Practice Address - Fax:305-933-9415
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2022-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME00722172084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270864OtherAVMED
FL3099719OtherGHI
FLH12370OtherVISTA
FL130023051OtherRAILROAD MEDICARE
FL33130OtherNHP
FL7379174OtherAETNA LIFE INS CO
FL7757600OtherCIGNA
FL51659OtherBLUE CROSS BLUE SHIELD
FL259003400Medicaid
FLN34556OtherWELLCARE/STAYWELL
FL1024837OtherCARE PLUS
FL216735OtherAMERIGROUP
FL400000501000OtherPREFERRED CARE PARTNERS
FL259003400Medicaid
FLE3873ZMedicare PIN