Healthcare Provider Details

I. General information

NPI: 1205872587
Provider Name (Legal Business Name): JEFFREY SCHUYLER CROSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 W 26TH AVE SUITE 420-C
DENVER CO
80211-5308
US

IV. Provider business mailing address

11700 W. 2ND PL SUITE #210
LAKEWOOD CO
80228
US

V. Phone/Fax

Practice location:
  • Phone: 303-480-3565
  • Fax: 303-480-3566
Mailing address:
  • Phone: 720-321-8080
  • Fax: 720-321-8081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number31856
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0425424
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: