Provider Demographics
NPI:1821046178
Name:GROSS, MARIO M (MD)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:M
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:900 GLADES RD FL 4
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6407
Mailing Address - Country:US
Mailing Address - Phone:561-430-3933
Mailing Address - Fax:561-430-3943
Practice Address - Street 1:900 GLADES RD FL 4
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:561-430-3933
Practice Address - Fax:561-430-3943
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126873207V00000X
TXK6596207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E18426Medicare UPIN