Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD00019697 | WA |
N | 207YS0123X | Facial Plastic Surgeon | MD00019697 | WA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MD00019697 | WA |
N | 208200000X | Surgeon | MD00019697 | WA |
N | 208600000X | Surgeon | MD00019697 | WA |
N | 208200000X | Surgeon | MD00019697 | WA |
N | 208600000X | Surgeon | MD00019697 | WA |
N | 2086S0122X | Plastic and Reconstructive Surgery | MD00019697 | WA |
N | 2086X0206X | Surgical Oncologist | MD00019697 | WA |
NPI | 1023082203 |
---|---|
Provider Name | James R Gross |
First Address | Mount Vernon, WA 98274-4127 |
Second Address | Mount Vernon, WA 98274-4036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 27/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D33847 | (02) | WA |