Provider Demographics
NPI:1023004660
Name:GROSS, STUART IRVING (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:IRVING
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 NE 171ST ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2732
Mailing Address - Country:US
Mailing Address - Phone:305-653-2039
Mailing Address - Fax:
Practice Address - Street 1:16190 NE 11TH CT
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4504
Practice Address - Country:US
Practice Address - Phone:305-944-3883
Practice Address - Fax:305-354-2210
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0015954207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063373900Medicaid
D59964Medicare UPIN
FL063373900Medicaid