Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 6053 | SD |
N | 207YS0123X | Facial Plastic Surgeon | A60281 | CA |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | N2537 | TX |
NPI | 1053386763 |
---|---|
Provider Name | Eric M Gross |
First Address | El Paso, TX 79936-5221 |
Second Address | El Paso, TX 79936-5221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 08/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4993122 | WELLMARK (01) | SD |
6053 | DAKOTACARE (01) | SD |
6520500 | (05) | SD |
H71742 | (02) | CA |
H71742 | (02) | TX |
P00439542 | RR MEDICARE (01) | SD |