Provider Demographics
NPI:1457395832
Name:GROS, ALBERT J JR (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:J
Last Name:GROS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-0069
Mailing Address - Country:US
Mailing Address - Phone:337-407-4512
Mailing Address - Fax:800-207-6956
Practice Address - Street 1:3983 I 49 S SERVICE RD
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-0758
Practice Address - Country:US
Practice Address - Phone:337-407-4512
Practice Address - Fax:800-207-6956
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025990207L00000X
LAMD.025590208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1049999Medicaid
LA1049999Medicaid
LA4K153Medicare PIN
LAP00384658Medicare PIN
LA4K153C203Medicare PIN