Provider Demographics
NPI:1790462455
Name:GROSS, HEZEKIAH
Entity Type:Individual
Prefix:
First Name:HEZEKIAH
Middle Name:
Last Name:GROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 PAYNE ST
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-5430
Mailing Address - Country:US
Mailing Address - Phone:448-207-0937
Mailing Address - Fax:
Practice Address - Street 1:90 PAYNE ST
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-5430
Practice Address - Country:US
Practice Address - Phone:448-207-0937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker