Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 3125941 | TX |
NPI | 1033708987 |
---|---|
Provider Name | Dr. Brandt Gros |
First Address | Dallas, TX 75219-4399 |
Second Address | Dallas, TX 75219-4399 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2021 |
Last Update Date | 14/01/2021 |