Provider Demographics
NPI:1114916756
Name:GROSS, WILLIAM ELSWORTH (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ELSWORTH
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1005 MAR WALT DRIVE
Mailing Address - Street 2:ADMIN
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6796
Mailing Address - Country:US
Mailing Address - Phone:850-863-8275
Mailing Address - Fax:850-314-6833
Practice Address - Street 1:1110 HOSPITAL ROAD
Practice Address - Street 2:OTOLARYNGOLOGY DEPARTMENT
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6796
Practice Address - Country:US
Practice Address - Phone:850-863-8275
Practice Address - Fax:850-314-6833
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME123489207Y00000X
TNMD25101207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016139100Medicaid
FLAZNV4OtherFLORIDA BLUE
FL016139100Medicaid
FLIJ639ZMedicare PIN