MEDICARE: ALISA CROSS 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
1	208600000X	Surgery Physician	31186	OK
2	208600000X	Surgery Physician	00-2040	GA
3	2086S0102X	Surgical Critical Care Physician	MD447864	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558549634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISA CROSS MD

Provider Business Mailing Address
First Line	:	800 STANTON L YOUNG BLVD # 9000
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5018
Country	:	US
Telephone Number	:	405-271-5781
Fax Number	:	405-271-3919

Provider Business Practice Location Address
First Line	:	800 STANTON L YOUNG BLVD # 9000
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5018
Country	:	US
Telephone Number	:	405-271-5781
Fax Number	:	405-271-3919

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	12/08/2021

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