Provider Demographics
NPI:1841363322
Name:CROSS, BETTY SUE (MD)
Entity type:Individual
Prefix:DR
First Name:BETTY
Middle Name:SUE
Last Name:CROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:336 NELDA AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-5439
Mailing Address - Country:US
Mailing Address - Phone:314-909-6552
Mailing Address - Fax:
Practice Address - Street 1:1765 OLD STATE ROUTE 21
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-3205
Practice Address - Country:US
Practice Address - Phone:636-296-4466
Practice Address - Fax:636-296-6561
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2J512080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine