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NPI Code Detail

MEDICARE: DR. J. CHRISS CANCRO MD

MEDICARE: DR. J. CHRISS CANCRO MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistMD00015504WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
169849OTHERWALABOR & INDUSTRIES
21151406OTHERWADSHS
3C142OTHERWAREGENCE

General Provider Information

NPI Number : 1245218668
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. J. CHRISS CANCRO MD
Provider Business Mailing Address
First Line : 122 3RD ST NE
Second Line :
City : AUBURN
State : WA
Zip : 98002-4013
Country : US
Telephone Number : 253-833-7750
Fax Number : 253-887-9804
Provider Business Practice Location Address
First Line : 122 3RD ST NE
Second Line :
City : AUBURN
State : WA
Zip : 98002-4013
Country : US
Telephone Number : 253-833-7750
Fax Number : 253-887-9804
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2006
Last Update Date : 04/11/2008

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