Provider Demographics
NPI:1811099401
Name:CROSS, GERILYN E (MD)
Entity type:Individual
Prefix:DR
First Name:GERILYN
Middle Name:E
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 1:934 N SUNCOAST BLVD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-5490
Mailing Address - Country:US
Mailing Address - Phone:352-794-6208
Mailing Address - Fax:352-794-6222
Practice Address - Street 1:934 N SUNCOAST BLVD
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-5490
Practice Address - Country:US
Practice Address - Phone:352-794-6208
Practice Address - Fax:352-794-6222
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54776207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G547760Medicaid
CA00G547760Medicaid
CAAX085ZMedicare PIN
CAWG54776FMedicare PIN