Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 25MD00289200 | NJ |
NPI | 1023140423 |
---|---|
Provider Name | Dr. Evan H Gross |
First Address | Gibbsboro, NJ 08026-1018 |
Second Address | Gibbsboro, NJ 08026-1018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 10/09/2007 |