Healthcare Provider Details

I. General information

NPI: 1003137944
Provider Name (Legal Business Name): JONATHAN CROSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 E 41ST ST STE 900
TULSA OK
74135-5631
US

IV. Provider business mailing address

PO BOX 4930
TULSA OK
74159-0930
US

V. Phone/Fax

Practice location:
  • Phone: 918-747-4975
  • Fax: 918-743-8552
Mailing address:
  • Phone: 918-747-4975
  • Fax: 918-743-8552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberQ4075
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC203414
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number27929
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: