Provider Demographics
NPI:1396827358
Name:GROSS, ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:GROSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6425 LYNCH CANYON DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ISABELLA
Mailing Address - State:CA
Mailing Address - Zip Code:93240-9726
Mailing Address - Country:US
Mailing Address - Phone:760-379-8630
Mailing Address - Fax:
Practice Address - Street 1:6425 LYNCH CANYON DR
Practice Address - Street 2:
Practice Address - City:LAKE ISABELLA
Practice Address - State:CA
Practice Address - Zip Code:93240-9726
Practice Address - Country:US
Practice Address - Phone:760-379-8630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7951207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5869361002OtherCIGNA POS
CA0076650242OtherPACIFICARE / SECURE HORIZONS
CAOHB253OtherBLUE CROSS
CA0033089489OtherHEALTHNET
CA421359OtherAETNA
CA5869361004OtherCIGNA HMO
CA020A79510OtherBLUE SHIELD
CAOHB253OtherBLUE CROSS
CAH53440Medicare UPIN