Provider Demographics
NPI:1568473031
Name:GROSS, DALE (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PROVIDENCE ANCHORAGE ANESTHESIA MEDICAL GROUP, P.C.
Mailing Address - Street 2:3300 PROVIDENCE DR., SUITE 207
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4619
Mailing Address - Country:US
Mailing Address - Phone:907-561-0005
Mailing Address - Fax:907-563-9140
Practice Address - Street 1:PROVIDENCE ANCHORAGE ANESTHESIA MEDICAL GROUP, P.C.
Practice Address - Street 2:3300 PROVIDENCE DR., SUITE 207
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4619
Practice Address - Country:US
Practice Address - Phone:907-561-0005
Practice Address - Fax:907-563-9140
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK4242207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK4242Medicaid
AK151588Medicare ID - Type Unspecified
AK4242Medicaid