Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 34005735 | OH |
NPI | 1013916717 |
---|---|
Provider Name | Dr. Wayne D Gross |
First Address | Massillon, OH 44646-3639 |
Second Address | Massillon, OH 44646-3639 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2005 |
Last Update Date | 29/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0925280 | (05) | OH |
F59756 | (02) | OH |