Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | E9671 | TX |
NPI | 1033116439 |
---|---|
Provider Name | Dr. Gary Edward Gross |
First Address | Tyler, TX 75701-2143 |
Second Address | Tyler, TX 75701-2143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 27/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
128154506 | (05) | TX |
C16331 | (02) |