Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 0101029581 | VA |
NPI | 1043299639 |
---|---|
Provider Name | Gary Paul Gross |
First Address | Salem, VA 24153-7357 |
Second Address | Salem, VA 24153-7357 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 16/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005900816 | (05) | VA |
B08590 | (02) | |
P00276914 | MEDICARE RAILROAD (01) | VA |