Provider Demographics
NPI:1801219944
Name:EDWARD J. GROSS, M.D., P.L.
Entity Type:Organization
Organization Name:EDWARD J. GROSS, M.D., P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-333-3040
Mailing Address - Street 1:1035 PRIMERA BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2193
Mailing Address - Country:US
Mailing Address - Phone:407-333-3040
Mailing Address - Fax:407-333-3496
Practice Address - Street 1:1035 PRIMERA BLVD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2193
Practice Address - Country:US
Practice Address - Phone:407-333-3040
Practice Address - Fax:407-333-3496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-25
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074351207N00000X
FLME74351207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Multi-Specialty