Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 36540 | KY |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MD00048649 | WA |
NPI | 1619932704 |
---|---|
Provider Name | Mr. Rick D Gross |
First Address | Yakima, WA 98902-2715 |
Second Address | Yakima, WA 98902-4882 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 20/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64031834 | (05) | KY |
H38019 | (02) | KY |