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NPI Code Detail

MEDICARE: DR. EVAN GROSS M.D.

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
1174400000XSpecialistME96840FL
2174400000XSpecialist2002018376MO
3207RN0300XNephrology PhysicianME96840FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID 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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