Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 06192 | SC |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 06192 | SC |
NPI | 1720002850 |
---|---|
Provider Name | Richard H Gross |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 06/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
061925 | (05) | SC |
D17510 | (02) | SC |