Provider Demographics
NPI:1508921784
Name:GROSS, GARY (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1550 DREW AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-1628
Mailing Address - Country:US
Mailing Address - Phone:530-771-0177
Mailing Address - Fax:530-771-0135
Practice Address - Street 1:1550 DREW AVE
Practice Address - Street 2:STE 100
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-1628
Practice Address - Country:US
Practice Address - Phone:530-771-0177
Practice Address - Fax:530-771-0135
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA32510207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0235816OtherCIGNA
MA0709026OtherUNITED HEALTH CARE
MAD32621OtherHARVARD PILGRIM
MA4294344OtherAETNA
MA700800OtherTUFTS HEALTH PLAN
MAM07809OtherBCBS OF MA
MAM07809Medicare ID - Type UnspecifiedMEDICARE
MA700800OtherTUFTS HEALTH PLAN