Healthcare Provider Details

I. General information

NPI: 1144649914
Provider Name (Legal Business Name): JOSHUA C GROSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 LEXINGTON AVE
ASHLAND KY
41101-3009
US

IV. Provider business mailing address

2841 LEXINGTON AVE
ASHLAND KY
41101-3009
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-2451
  • Fax: 606-324-7123
Mailing address:
  • Phone: 606-324-2451
  • Fax: 606-324-2451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.139148
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number53714
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01077499A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: