Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | M7344 | ID |
Y | 207X00000X | Orthopaedic Surgeon | Q1618 | TX |
N | 207XS0106X | Orthopaedic Hand Surgeon | M7344 | ID |
NPI | 1275572307 |
---|---|
Provider Name | Dr. Dominic L Gross |
First Address | El Paso, TX 79902-5806 |
Second Address | El Paso, TX 79902-5806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 04/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G60728 | (02) |