| Doctor Name: | MARK CROSS |
| NPI Number: | 1205964939 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 2322 |
| Business Practice Address: | 874 Main St Fortuna, CA - 955401926 |
| Business Phone Number: | 7077253334 |
| Business Fax Number: | 7077252455 |
| Mailing Address: | 874 Main St, FORTUNA |
| State: | CA |
| Postal Code: | 955401926 |
| Phone Number: | 7077253334 |
| Fax Number: | 7077252455 |
| NPI Enumeration Date: | 03/02/2007 |
| NPI Last Update Date: | 09/25/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 2322 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |