Provider Demographics
NPI:1750590725
Name:JONATHON GROSS MD PLLC
Entity type:Organization
Organization Name:JONATHON GROSS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:LOBER
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-529-2940
Mailing Address - Street 1:PO BOX 35448
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-5448
Mailing Address - Country:US
Mailing Address - Phone:520-529-2940
Mailing Address - Fax:520-229-1207
Practice Address - Street 1:7440 N ORACLE RD
Practice Address - Street 2:CASITA #4
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6385
Practice Address - Country:US
Practice Address - Phone:520-529-2940
Practice Address - Fax:520-229-1207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28061207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ101771Medicare PIN