Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 029910 | CT |
N | 2086S0105X | Surgery of the Hand | 29910 | CT |
NPI | 1740484187 |
---|---|
Provider Name | Stewart Cory Gross |
First Address | Bridgeport, CT 06606-5301 |
Second Address | Bridgeport, CT 06606-5301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 14/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001125 | HEALTHNET (01) | CT |
001299107 | (05) | CT |
010029910CT01 | BLUE CROSS BLUE SHIELD (01) | CT |
4351331 | AETNA US HEALTH CARE (01) | CT |
D80877 | (02) | |
ZS224 | OXFORD (01) | CT |