Provider Demographics
NPI:1144262163
Name:CROSS, THOMAS L (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:CROSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:34612 6TH AVE S STE 300
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8723
Mailing Address - Country:US
Mailing Address - Phone:253-838-8552
Mailing Address - Fax:253-874-6089
Practice Address - Street 1:34612 6TH AVE S STE 300
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8723
Practice Address - Country:US
Practice Address - Phone:253-838-8552
Practice Address - Fax:253-874-6089
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00001222204C00000X
WAOP00001222207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1052596Medicaid
WA0219677OtherSTATE L&I
WA0219677OtherSTATE L&I
WAE16461Medicare UPIN
WAG8865069Medicare PIN