Healthcare Provider Details

I. General information

NPI: 1871568626
Provider Name (Legal Business Name): CRAIG G GROSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E GRANT RD
TUCSON AZ
85712-2805
US

IV. Provider business mailing address

7140 E ROSEWOOD ST SUITE B
TUCSON AZ
85710-1346
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-5461
  • Fax: 520-324-1406
Mailing address:
  • Phone: 520-547-4900
  • Fax: 520-547-2435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25493
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: