Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 030078 | GA |
N | 207NS0135X | Procedural Dermatology | 030078 | GA |
NPI | 1306826490 |
---|---|
Provider Name | Dr. Alexander S Gross |
First Address | Cumming, GA 30041 |
Second Address | Cumming, GA 30041-7623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 09/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000509858D | (05) | GA |
070015702 | RR MEDICARE (01) | GA |
D45501 | (02) | GA |
GRP6141 | MEDICARE ID-TYPE UNSPECIFIED (01) | GA |