Healthcare Provider Details

I. General information

NPI: 1457395832
Provider Name (Legal Business Name): ALBERT J GROS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3983 I 49 S SERVICE RD
OPELOUSAS LA
70570-0758
US

IV. Provider business mailing address

PO BOX 69
OPELOUSAS LA
70571-0069
US

V. Phone/Fax

Practice location:
  • Phone: 337-407-4512
  • Fax: 800-207-6956
Mailing address:
  • Phone: 337-284-3200
  • Fax: 800-207-6956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD.025590
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number025990
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: