MEDICARE: ERIC M GROSS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	N2537	TX
2	207YS0123X	Facial Plastic Surgery Physician	6053	SD
3	207YS0123X	Facial Plastic Surgery Physician	A60281	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00439542	OTHER	SD	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6053	OTHER	SD	DAKOTACARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	4993122	OTHER	SD	WELLMARK

General Provider Information

NPI Number	:	1053386763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC M GROSS MD

Provider Business Mailing Address
First Line	:	2400 TRAWOOD DR STE 304
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-4122
Country	:	US
Telephone Number	:	915-591-8400
Fax Number	:	915-591-8401

Provider Business Practice Location Address
First Line	:	2400 TRAWOOD DR STE 304
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-4122
Country	:	US
Telephone Number	:	915-591-8400
Fax Number	:	915-591-8401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	02/12/2024

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Directions to “ ERIC M GROSS MD” Practice Location

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