Provider Demographics
NPI:1144383555
Name:GROS, ALBERT THAD (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:THAD
Last Name:GROS
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 1:4007 JAMES CASEY
Mailing Address - Street 2:A250
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745
Mailing Address - Country:US
Mailing Address - Phone:512-441-9796
Mailing Address - Fax:512-441-8448
Practice Address - Street 1:4007 JAMES CASEY
Practice Address - Street 2:A250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745
Practice Address - Country:US
Practice Address - Phone:512-441-9796
Practice Address - Fax:512-441-8448
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6387207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0013Q54Medicare ID - Type Unspecified
C16328Medicare UPIN