Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | ME0073065 | FL |
N | 207U00000X | Nuclear Medicine Specialist | ME0073065 | FL |
NPI | 1194791293 |
---|---|
Provider Name | Bernard Joseph Gros |
First Address | Orlando, FL 32817-1492 |
Second Address | Orlando, FL 32817-1492 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 07/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
251964000 | (05) | FL |
G51582 | (02) | FL |