Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | ME0015954 | FL |
NPI | 1023004660 |
---|---|
Provider Name | Stuart Irving Gross |
First Address | North Miami Beach, FL 33162-2732 |
Second Address | North Miami Beach, FL 33162-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 18/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
063373900 | (05) | FL |
D59964 | (02) |