Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | MD00031954 | WA |
NPI | 1316978281 |
---|---|
Provider Name | Scott Edward Grosse |
First Address | Wenatchee, WA 98801-2028 |
Second Address | Spokane, WA 99204-2800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
107844 | L&I (01) | WA |
8195422 | (05) | WA |
G26461 | (02) | WA |