Provider Demographics
NPI:1457337156
Name:GROSS, LORI LYNN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:LYNN
Last Name:GROSS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:LYNN
Other - Last Name:GROSS HOLSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 NW 23RD PL
Mailing Address - Street 2:SUITE 6, #324
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-5580
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 NW 23RD PL
Practice Address - Street 2:SUITE 6, #324
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-5580
Practice Address - Country:US
Practice Address - Phone:360-574-4795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2016-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD270272083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine