Provider Demographics
NPI:1487123808
Name:CROSS, DUANE
Entity type:Individual
Prefix:
First Name:DUANE
Middle Name:
Last Name:CROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3370 GIBRALTER HEIGHTS DR APT B5
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43609-1256
Mailing Address - Country:US
Mailing Address - Phone:419-973-9097
Mailing Address - Fax:
Practice Address - Street 1:3370 GIBRALTER HEIGHTS DR APT B5
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43609-1256
Practice Address - Country:US
Practice Address - Phone:419-973-9097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1715308347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker