Provider Demographics
NPI:1033472220
Name:GROSS, ARIEL L (PA)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:L
Last Name:GROSS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 880
Mailing Address - Street 2:
Mailing Address - City:ST. IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865
Mailing Address - Country:US
Mailing Address - Phone:406-745-3525
Mailing Address - Fax:406-745-3529
Practice Address - Street 1:35959 BIG KNIFE LANE
Practice Address - Street 2:
Practice Address - City:PABLO
Practice Address - State:MT
Practice Address - Zip Code:59855
Practice Address - Country:US
Practice Address - Phone:406-752-8433
Practice Address - Fax:406-756-6768
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT32693363A00000X
OR156936363AS0400X
MTMED-PAC-LIC-32693363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical