Provider Demographics
NPI:1962939967
Name:CROSS, CASSANDRA PADEN (MD)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:PADEN
Last Name:CROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2120
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2120
Mailing Address - Country:US
Mailing Address - Phone:541-274-6556
Mailing Address - Fax:
Practice Address - Street 1:3000 BRYANT WILLIAMS DR STE 102
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1139
Practice Address - Country:US
Practice Address - Phone:541-274-6101
Practice Address - Fax:541-274-6101
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN642282084N0400X
ORMD2059152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology