MEDICARE: DR. EVAN 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	174400000X	Specialist	ME96840	FL
2	174400000X	Specialist	2002018376	MO
3	207RN0300X	Nephrology Physician	ME96840	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	:	1881646602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVAN GROSS M.D.

Provider Business Mailing Address
First Line	:	7981 GLADIOLUS DR
Second Line	:
City	:	FT MYERS
State	:	FL
Zip	:	33908-4154
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7981 GLADIOLUS DR
Second Line	:
City	:	FT MYERS
State	:	FL
Zip	:	33908-4154
Country	:	US
Telephone Number	:	239-939-0999
Fax Number	:

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	12/20/2022

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Directions to “ DR. EVAN GROSS M.D.” Practice Location

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