Provider Demographics
NPI:1952905549
Name:CROSS, AUSTIN G (MD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:G
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 1:3601 4TH ST STOP 9436
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-9436
Mailing Address - Country:US
Mailing Address - Phone:806-743-2622
Mailing Address - Fax:
Practice Address - Street 1:3601 4TH ST STOP 9436
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-9436
Practice Address - Country:US
Practice Address - Phone:806-743-2622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2022-06-28
Deactivation Date:2022-05-26
Deactivation Code:
Reactivation Date:2022-06-27
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXBP10080295207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program