Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | D6588 | TX |
NPI | 1285601336 |
---|---|
Provider Name | Mr. Gary Neil Gross |
First Address | Dallas, TX 75231 |
Second Address | Dallas, TX 75231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C16330 | (02) |