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NPI Code Detail

MEDICARE: DR. ROBERT GROSS DO

MEDICARE: DR. ROBERT GROSS DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician20A7951CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15869361002OTHERCACIGNA POS
20076650242OTHERCAPACIFICARE / SECURE HORIZONS
3OHB253OTHERCABLUE CROSS
40033089489OTHERCAHEALTHNET
5421359OTHERCAAETNA
65869361004OTHERCACIGNA HMO
7020A79510OTHERCABLUE SHIELD

General Provider Information

NPI Number : 1396827358
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT GROSS DO
Provider Business Mailing Address
First Line : 6425 LYNCH CANYON DR
Second Line :
City : LAKE ISABELLA
State : CA
Zip : 93240-9726
Country : US
Telephone Number : 760-379-8630
Fax Number :
Provider Business Practice Location Address
First Line : 6425 LYNCH CANYON DR
Second Line :
City : LAKE ISABELLA
State : CA
Zip : 93240-9726
Country : US
Telephone Number : 760-379-8630
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2006
Last Update Date : 06/30/2008

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