MEDICARE: DR. EDWARD A. GROSS M.D.

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	207NS0135X	Procedural Dermatology Physician	ME0074984	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164475257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD A. GROSS M.D.

Provider Business Mailing Address
First Line	:	860 SAN PEDRO AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33156-6339
Country	:	US
Telephone Number	:	305-672-5811
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 ARTHUR GODFREY RD
Second Line	:	SUITE 302
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-3641
Country	:	US
Telephone Number	:	305-672-5811
Fax Number	:	305-672-9182

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	12/14/2015

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Directions to “ DR. EDWARD A. GROSS M.D.” Practice Location

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