Provider Demographics
NPI:1700810538
Name:GROSS, SHAWN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:JAMES
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3939 W 50TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1258
Mailing Address - Country:US
Mailing Address - Phone:952-920-2020
Mailing Address - Fax:952-920-3225
Practice Address - Street 1:3939 W 50TH ST STE 200
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1258
Practice Address - Country:US
Practice Address - Phone:952-920-2020
Practice Address - Fax:952-920-3225
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN44700207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH66187Medicare UPIN