Healthcare Provider Details

I. General information

NPI: 1285601336
Provider Name (Legal Business Name): GARY NEIL GROSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5499 GLEN LAKES DRIVE STE 100
DALLAS TX
75231
US

IV. Provider business mailing address

5499 GLEN LAKES DRIVE STE 100
DALLAS TX
75231
US

V. Phone/Fax

Practice location:
  • Phone: 214-691-1330
  • Fax: 214-691-6405
Mailing address:
  • Phone: 214-691-1330
  • Fax: 214-691-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberD6588
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: