Provider Demographics
NPI:1871527986
Name:CROSS, VERONICA LYNN (MD)
Entity type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:LYNN
Last Name:CROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:VERONICA
Other - Middle Name:LYNN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5471 DR. MARTIN LUTHER KING DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST.LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-4265
Mailing Address - Country:US
Mailing Address - Phone:314-367-5820
Mailing Address - Fax:314-367-6326
Practice Address - Street 1:5471 DR. MARTIN LUTHER KING DRIVE
Practice Address - Street 2:
Practice Address - City:ST.LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-4265
Practice Address - Country:US
Practice Address - Phone:314-367-5820
Practice Address - Fax:314-367-6326
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108276207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205047046Medicaid
H04580Medicare UPIN