=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104008770
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID H GROSS D.P.M.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2007
-----------------------------------------------------
Last Update Date | 02/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ONE BEACH DR S.E. UNIT 910
-----------------------------------------------------
City | ST. PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-798-8201
-----------------------------------------------------
Fax | 727-526-2700
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ONE BEACH DR S.E. UNIT 910
-----------------------------------------------------
City | ST. PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-798-8201
-----------------------------------------------------
Fax | 727-526-2700
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | PO 0000560
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------