Provider Demographics
NPI:1801194196
Name:JD GROSS MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JD GROSS MEDICAL CORPORATION
Other - Org Name:ARIZONA MEDICAL MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-378-1100
Mailing Address - Street 1:2701 HARBOR BLVD
Mailing Address - Street 2:BLDG #E2, SUITE 214
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5153
Mailing Address - Country:US
Mailing Address - Phone:714-378-1100
Mailing Address - Fax:714-378-1150
Practice Address - Street 1:2418 E DANBURY RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2425
Practice Address - Country:US
Practice Address - Phone:714-378-1100
Practice Address - Fax:714-378-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79394207T00000X
CA20A9441207X00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty