Healthcare Provider Details

I. General information

NPI: 1508921784
Provider Name (Legal Business Name): GARY GROSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 DREW AVE STE 100
DAVIS CA
95618-1628
US

IV. Provider business mailing address

1550 DREW AVE STE 100
DAVIS CA
95618-1628
US

V. Phone/Fax

Practice location:
  • Phone: 530-771-0177
  • Fax: 530-771-0135
Mailing address:
  • Phone: 530-771-0177
  • Fax: 530-771-0135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number32510
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: