Provider Demographics
NPI:1073667077
Name:GROSS, EARL GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:GEORGE
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:PO BOX 1151
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-1151
Mailing Address - Country:US
Mailing Address - Phone:252-222-4533
Mailing Address - Fax:252-808-2095
Practice Address - Street 1:3610 MEDICAL PARK COURT
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557
Practice Address - Country:US
Practice Address - Phone:252-808-3376
Practice Address - Fax:252-808-2095
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99-00855207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1235YOtherBLUE CROSS OF NC
NC891235YMedicaid
NC1235YOtherBLUE CROSS OF NC
D02536Medicare UPIN