Provider Demographics
NPI:1033200795
Name:GROSS, ROBERT O (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:O
Last Name:GROSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-0145
Mailing Address - Country:US
Mailing Address - Phone:641-357-2141
Mailing Address - Fax:641-357-4315
Practice Address - Street 1:800 1ST AVE N
Practice Address - Street 2:SUITE #1
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-1725
Practice Address - Country:US
Practice Address - Phone:641-357-2141
Practice Address - Fax:641-357-4315
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01767208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16725OtherWELLMARK
IAA01522Medicare UPIN
IA16725Medicare ID - Type Unspecified