Provider Demographics
NPI:1851578314
Name:CRAIG G GROSS MD PC
Entity Type:Organization
Organization Name:CRAIG G GROSS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:G
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-547-4900
Mailing Address - Street 1:7140 E ROSEWOOD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1346
Mailing Address - Country:US
Mailing Address - Phone:520-547-4900
Mailing Address - Fax:520-547-2435
Practice Address - Street 1:7140 E ROSEWOOD ST
Practice Address - Street 2:SUITE B
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1346
Practice Address - Country:US
Practice Address - Phone:520-547-4900
Practice Address - Fax:520-547-2435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z66867Medicare PIN