Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | NC2118 | NC |
NPI | 1104860014 |
---|---|
Provider Name | Dr. Tom A Gross |
First Address | Horse Shoe, NC 28742 |
Second Address | Horse Shoe, NC 28742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 10/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0847B | BLUE CROSS OF NC (01) | NC |
0847B | NC STATE HEALTH PLAN (01) | NC |
890847B | (05) | NC |
U55304 | (02) |