Provider Demographics
NPI:1043221054
Name:GROSS, ROBERT D (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
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 1:911 23RD ST
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-4600
Mailing Address - Country:US
Mailing Address - Phone:806-655-2104
Mailing Address - Fax:806-655-0522
Practice Address - Street 1:911 23RD ST
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-4600
Practice Address - Country:US
Practice Address - Phone:806-655-2104
Practice Address - Fax:806-655-0522
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9508207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A0910OtherBCBS
TX114100100OtherFIRST CARE
TX132045904Medicaid
TX092485403Medicaid
TX8AN910OtherBCBS
8656K1Medicare PIN
TX8A0910OtherBCBS
TX132045904Medicaid