Provider Demographics
NPI:1184693939
Name:CROSS, STEPHANIE B (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:B
Last Name:CROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 ALCOA HWY
Mailing Address - Street 2:150
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1527
Mailing Address - Country:US
Mailing Address - Phone:865-546-1642
Mailing Address - Fax:865-305-6195
Practice Address - Street 1:1932 ALCOA HWY
Practice Address - Street 2:150
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1527
Practice Address - Country:US
Practice Address - Phone:865-546-1642
Practice Address - Fax:865-305-6196
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21352207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3068698Medicaid
TNF31304Medicare UPIN
TN3068694Medicare PIN
TN3068698Medicaid
TN3068690Medicare PIN