Healthcare Provider Details

I. General information

NPI: 1780686642
Provider Name (Legal Business Name): LAWRENCE B GROSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 NEW COVINGTON PIKE
MEMPHIS TN
38128-2504
US

IV. Provider business mailing address

5885 AIRLINE RD UNIT 1017
ARLINGTON TN
38002-5123
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-5211
  • Fax:
Mailing address:
  • Phone: 901-317-7427
  • Fax: 901-317-7585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20132
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: