Provider Demographics
NPI:1780926295
Name:LACROSS, CHRISTOPHER PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:PAUL
Last Name:LACROSS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 E COMMERCIAL BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4228
Mailing Address - Country:US
Mailing Address - Phone:954-667-3385
Mailing Address - Fax:954-676-1010
Practice Address - Street 1:2800 E COMMERCIAL BLVD STE 210
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4228
Practice Address - Country:US
Practice Address - Phone:954-667-3385
Practice Address - Fax:954-676-1010
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128412207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018842600Medicaid