Provider Demographics
NPI:1831181494
Name:CROSS, RICHARD NEALE (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:NEALE
Last Name:CROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 EAST ST
Mailing Address - Street 2:STE A
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0834
Mailing Address - Country:US
Mailing Address - Phone:530-768-1663
Mailing Address - Fax:530-768-1666
Practice Address - Street 1:2160 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2530
Practice Address - Country:US
Practice Address - Phone:530-244-2663
Practice Address - Fax:530-244-4309
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46134207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A461340Medicaid
CA680416959OtherTAX ID#
CA680416959OtherTAX ID#
CA00A461340Medicare PIN