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General NPI Number Information
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NPI Number | 1639276108
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Entity Type | Individual
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Provider Name | JOHN A. GROSS M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/19/2006
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Last Update Date | 12/22/2017
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Provider Practice Location Address
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Address Line | 116 1ST STREET NORTH
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City | ST. PETERSBURG
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State | FL
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Zip | 33701
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Country | US
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Telephone | 727-895-5210
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Fax | 727-821-4297
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Provider Business Mailing Address
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Address Line | PO BOX 10744
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City | CLEARWATER
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State | FL
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Zip | 33757-8744
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Country | US
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Telephone | 727-532-0002
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Fax | 727-266-4943
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME89948
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | ME89948
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License Number State | FL
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