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General NPI Number Information
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NPI Number | 1457501934
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Entity Type | Organization
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Legal Business Name | DAVID J GROSS MD PA
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Dates
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Enumeration Date | 09/22/2008
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 1100 S PONCE DE LEON BLVD STE 3B
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-6013
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Country | US
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Telephone | 904-823-9992
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Fax |
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Provider Business Mailing Address
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Address Line | 1100-3 S PONCE DE LEON BLVD SUITE 3B
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-6013
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Country | US
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Telephone | 904-823-9992
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID J GROSS
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Credential | MD
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Telephone | 904-823-9992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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