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General NPI Number Information
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NPI Number | 1932186939
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Entity Type | Individual
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Provider Name | SCOTT G CROSS MD
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Gender | Male
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Dates
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Enumeration Date | 12/30/2005
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 3100 CHANNING WAY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7533
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Country | US
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Telephone | 208-535-4130
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Fax | 208-535-4125
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Provider Business Mailing Address
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Address Line | 2860 CHANNING WAY SUITE 115B
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7531
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Country | US
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Telephone | 208-535-4103
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Fax | 208-535-4125
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0005X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
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License Number | M7984
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | M-7984
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License Number State | ID
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