MEDICARE: DR. BRIAN WESLEY CROSS M.D.

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
1	208800000X	Urology Physician	31201	OK

General Provider Information

NPI Number	:	1891954095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN WESLEY CROSS M.D.

Provider Business Mailing Address
First Line	:	UNIVERSITY OF OKLAHOMA DEPT OF UROLOGY
Second Line	:	920 SL YOUNG BLVD, WP 2140
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-0001
Country	:	US
Telephone Number	:	405-271-6966
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 SL YOUNG BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-1013
Country	:	US
Telephone Number	:	405-271-6966
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	04/07/2020

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