Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 29103 | NE |
NPI | 1013283431 |
---|---|
Provider Name | Dr. Daniel J Gross |
First Address | Omaha, NE 68102-3146 |
Second Address | Omaha, NE 68102-3146 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2012 |
Last Update Date | 29/10/2018 |