Provider Demographics
NPI:1104008770
Name:GROSS, DAVID H (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:GROSS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE BEACH DR S.E. UNIT 910
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701
Mailing Address - Country:US
Mailing Address - Phone:727-798-8201
Mailing Address - Fax:727-526-2700
Practice Address - Street 1:ONE BEACH DR S.E. UNIT 910
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701
Practice Address - Country:US
Practice Address - Phone:727-798-8201
Practice Address - Fax:727-526-2700
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 0000560213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87247Medicare PIN
FLT55387Medicare UPIN
T55387Medicare UPIN
FL3899750001Medicare NSC
87247Medicare PIN