Healthcare Provider Details

I. General information

NPI: 1346907151
Provider Name (Legal Business Name): JAMES STEVEN CROSS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E 1ST ST STE 404
DULUTH MN
55805-2265
US

IV. Provider business mailing address

1000 E 1ST ST STE 404
DULUTH MN
55805-2297
US

V. Phone/Fax

Practice location:
  • Phone: 218-722-5513
  • Fax: 218-722-7173
Mailing address:
  • Phone: 218-722-5513
  • Fax: 218-722-7173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13966
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: