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NPI Code Detail

MEDICARE: HEATHER KAY CROSS MD

MEDICARE: HEATHER KAY CROSS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianME139886FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760913248
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER KAY CROSS MD
Provider Business Mailing Address
First Line : 655 W 8TH ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32209-6511
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 800 PRUDENTIAL DR
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8211
Country : US
Telephone Number : 904-349-7761
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2017
Last Update Date : 08/07/2022

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