Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | 036142698 | IL |
N | 213ES0000X | Sports Medicine | 036142698 | IL |
Y | 2081S0010X | Sports Medicine | 10892773-1205 | UT |
Y | 213ES0000X | Sports Medicine | 10892773-1205 | UT |
NPI | 1144664681 |
---|---|
Provider Name | Claire A Gross |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | Provo, UT 84604-6124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2013 |
Last Update Date | 03/10/2018 |