Provider Demographics
NPI:1912085051
Name:GROSS PIERCE, STEPHANIE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LYNN
Last Name:GROSS PIERCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1850 W LAKE HOUSTON PKWY
Mailing Address - Street 2:STE 190
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-5237
Mailing Address - Country:US
Mailing Address - Phone:281-361-2902
Mailing Address - Fax:281-361-5792
Practice Address - Street 1:1850 W LAKE HOUSTON PKWY
Practice Address - Street 2:STE. 190
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-5237
Practice Address - Country:US
Practice Address - Phone:281-361-2902
Practice Address - Fax:281-361-5792
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4173207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00097FMedicare ID - Type Unspecified
TXF85030Medicare UPIN