Healthcare Provider Details

I. General information

NPI: 1316978281
Provider Name (Legal Business Name): SCOTT EDWARD GROSSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W 5TH AVE STE 323
SPOKANE WA
99204-2800
US

IV. Provider business mailing address

820 N CHELAN AVE
WENATCHEE WA
98801-2028
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-2531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD00031954
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: