Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 17646 | SC |
NPI | 1013918275 |
---|---|
Provider Name | Dr. Thomas P Gross |
First Address | Columbia, SC 29201-3520 |
Second Address | Columbia, SC 29201-3520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 15/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E90700 | (02) | SC |
T11663 | (05) | SC |