Provider Demographics
NPI:1528022399
Name:JAMES L. GROSS, DO, PC
Entity Type:Organization
Organization Name:JAMES L. GROSS, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-614-2242
Mailing Address - Street 1:10250 N 92ND ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4510
Mailing Address - Country:US
Mailing Address - Phone:480-614-2242
Mailing Address - Fax:480-614-2252
Practice Address - Street 1:10250 N 92ND ST
Practice Address - Street 2:SUITE 206
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4510
Practice Address - Country:US
Practice Address - Phone:480-614-2242
Practice Address - Fax:480-614-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ016742Medicaid
AZZ66186Medicare ID - Type Unspecified
AZ016742Medicaid