Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 14104 | NE |
NPI | 1033150677 |
---|---|
Provider Name | Richard Michael Gross |
First Address | Omaha, NE 68130-2396 |
Second Address | Omaha, NE 68124-2372 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 15/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02647 | BCBS OF NEBRASKA (01) | NE |
09-00178 | SHARE ADVANTAGE/MERCY RD (01) | NE |
09-01135 | SHARE ADVANTAGE/LAKESIDE (01) | NE |
0922500 | (05) | IA |
14914 | MIDLANDS CHOICE (01) | NE |
47063010113 | (05) | NE |
D92370 | (02) | NE |