Provider Demographics
NPI:1609862846
Name:GROSS, JASON P (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:P
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2460 WILLAMETTE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3169
Mailing Address - Country:US
Mailing Address - Phone:541-683-3744
Mailing Address - Fax:541-683-6672
Practice Address - Street 1:2460 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3169
Practice Address - Country:US
Practice Address - Phone:541-683-3744
Practice Address - Fax:541-683-6672
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2018-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077983207W00000X
ORMD153855207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500687131Medicaid
MI104967123Medicaid
MI180H27019OtherBCBS OF MICHIGAN
MIP00390624OtherPALMETTO GBA
MI104983299Medicaid
MI180H27019OtherBLUE CARE NETWORK
MI382155439OtherCOMMERCIAL INSURANCE
MI104983299Medicaid