Provider Demographics
NPI:1770794695
Name:CROSS, JOHN LOWRY (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LOWRY
Last Name:CROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-227-3205
Practice Address - Street 1:1190 N STATE ST STE 204
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2413
Practice Address - Country:US
Practice Address - Phone:601-973-1624
Practice Address - Fax:601-973-1596
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20080207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01309015Medicaid
MSP01245386OtherRAILROAD MEDICARE
MS302I118613Medicare PIN
MS538716YJ5JMedicare PIN
MS01309015Medicaid
MSP00775908Medicare PIN