Healthcare Provider Details

I. General information

NPI: 1548370463
Provider Name (Legal Business Name): LORNE M CROSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 LIBERTY ST SE
SALEM OR
97302-4143
US

IV. Provider business mailing address

PO BOX 2040
PORTLAND OR
97208-2040
US

V. Phone/Fax

Practice location:
  • Phone: 503-391-9762
  • Fax: 503-315-2019
Mailing address:
  • Phone: 503-299-9906
  • Fax: 503-225-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG80144
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD27400
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License NumberMD27400
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: