Provider Demographics
NPI:1467458273
Name:GROSS, HOWARD MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:MICHAEL
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1722 STATE STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101
Mailing Address - Country:US
Mailing Address - Phone:805-898-2600
Mailing Address - Fax:805-898-2604
Practice Address - Street 1:1722 STATE STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101
Practice Address - Country:US
Practice Address - Phone:805-898-2600
Practice Address - Fax:805-898-2604
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG061854174400000X
CAG61854208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G618541Medicaid
CA00G618541Medicaid
CAF36140Medicare UPIN