Provider Demographics
NPI:1619932704
Name:GROSS, RICK D (MD)
Entity Type:Individual
Prefix:MR
First Name:RICK
Middle Name:D
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3800 SUMMITVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2715
Mailing Address - Country:US
Mailing Address - Phone:606-676-0555
Mailing Address - Fax:606-676-0556
Practice Address - Street 1:1601 CREEKSIDE LOOP
Practice Address - Street 2:YAKIMA EAR NOSE AND THROAT
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4882
Practice Address - Country:US
Practice Address - Phone:509-575-1000
Practice Address - Fax:509-225-2703
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36540207YX0905X
WAMD00048649207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64031834Medicaid
KY1881601Medicare ID - Type Unspecified
KY64031834Medicaid