Provider Demographics
NPI:1790821163
Name:GROSS, ROBERT ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3831 HUGHES AVE
Mailing Address - Street 2:# 706
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-6840
Mailing Address - Country:US
Mailing Address - Phone:310-204-4044
Mailing Address - Fax:310-204-1449
Practice Address - Street 1:3831 HUGHES AVE
Practice Address - Street 2:# 706
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-6840
Practice Address - Country:US
Practice Address - Phone:310-204-4044
Practice Address - Fax:310-204-1449
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2010-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG21342207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G21342Medicaid
CAG21342Medicare PIN
CA000G21342Medicaid