Lyndon Bernard Gross
Sports Medicine Doctor
14825 N Outer 40 Suite 200
Chesterfield
, Missouri 63017-2026
Lyndon Bernard Gross
Sports Medicine Doctor
14825 N Outer 40 Suite 200
Chesterfield
, Missouri 63017-2026
(314) 336-2555
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About
Features
Specialties
- Sports Medicine Doctor
Languages spoken
- English
Location
First Address
- Lyndon Bernard Gross
- 14825 N Outer 40 Suite 200
- Chesterfield, MO
- Zip : 63017-2026
- Phone : (314) 336-2555
Second Address
- Lyndon Bernard Gross
- 14825 N Outer 40 Suite 200
- Chesterfield, MO
- Zip : 63017-2026
- Phone : (314) 336-2555
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 204C00000X | Sports Medicine Doctor | 119343 | MO |
National Provider Identifier
| NPI | 1215902648 |
|---|---|
| Provider Name | Lyndon Bernard Gross |
| First Address | Chesterfield, MO 63017-2026 |
| Second Address | Chesterfield, MO 63017-2026 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 20/02/2006 |
| Last Update Date | 10/02/2011 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| G82897 | (02) | MO |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.