Provider Demographics
NPI:1326035387
Name:GROSS, MAJOR RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MAJOR
Middle Name:RYAN
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 1:2620 WHEATON WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3319
Mailing Address - Country:US
Mailing Address - Phone:360-377-3923
Mailing Address - Fax:360-373-4988
Practice Address - Street 1:2620 WHEATON WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3335
Practice Address - Country:US
Practice Address - Phone:360-377-3923
Practice Address - Fax:360-373-4988
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032849207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8197154Medicaid
WA91114366510OtherKPS HEALTHPLANS
WA91114366598310A010OtherTRICARE
WA136044OtherLABOR & INDUSTRIES
WA1665GROtherREGENCE
WAMD00032849OtherMD LICENSE CREDENTIAL NUMBER
WAAB17920Medicare ID - Type Unspecified
WA136044OtherLABOR & INDUSTRIES