Provider Demographics
NPI:1700908654
Name:GRACE H YOO M D AND GERALD A ROSS DO PA
Entity Type:Organization
Organization Name:GRACE H YOO M D AND GERALD A ROSS DO PA
Other - Org Name:COASTAL OBGYN SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-785-8000
Mailing Address - Street 1:501 NW LAKE WHITNEY PLACE
Mailing Address - Street 2:#106
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3443
Mailing Address - Country:US
Mailing Address - Phone:772-785-8000
Mailing Address - Fax:772-785-8150
Practice Address - Street 1:501 NW LAKE WHITNEY PLACE
Practice Address - Street 2:#106
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3443
Practice Address - Country:US
Practice Address - Phone:772-785-8000
Practice Address - Fax:772-785-8150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8788207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34612OtherBCBS
FL34612Medicare ID - Type Unspecified