Provider Demographics
NPI:1245209550
Name:GROSS, JOHN C (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
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 1:2841 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-3009
Mailing Address - Country:US
Mailing Address - Phone:606-324-2451
Mailing Address - Fax:606-324-7123
Practice Address - Street 1:2841 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-3009
Practice Address - Country:US
Practice Address - Phone:606-324-2451
Practice Address - Fax:606-324-7123
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28089207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0160061Medicaid
KY64280894Medicaid
KY180021151OtherMEDICARE RAILROAD
KY180021151OtherMEDICARE RAILROAD
KY0987301Medicare ID - Type Unspecified