Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | ME151455 | TX |
NPI | 1194172130 |
---|---|
Provider Name | Bruno Gross |
First Address | Dallas, TX 75390-7201 |
Second Address | Weston, FL 33331-3625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2016 |
Last Update Date | 12/07/2021 |