Provider Demographics
NPI:1609894211
Name:GROSS, STEVEN A (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:32615 U.S. 19 NORTH
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684
Mailing Address - Country:US
Mailing Address - Phone:727-772-7712
Mailing Address - Fax:727-772-6891
Practice Address - Street 1:32615 U.S. 19 NORTH
Practice Address - Street 2:SUITE 6
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684
Practice Address - Country:US
Practice Address - Phone:727-772-7712
Practice Address - Fax:727-772-6891
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME62730207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371349100Medicaid
FL18084OtherBLUE CROSS AND BLUE SHIEL
FL18084UMedicare PIN
FL371349100Medicaid