MEDICARE: DR. SHELDON G. 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	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	E8526	TX

General Provider Information

NPI Number	:	1922001395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELDON G. GROSS MD

Provider Business Mailing Address
First Line	:	4499 MEDICAL DR
Second Line	:	STE 396
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3713
Country	:	US
Telephone Number	:	210-614-3737
Fax Number	:	210-614-3147

Provider Business Practice Location Address
First Line	:	4499 MEDICAL DR
Second Line	:	STE 396
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3713
Country	:	US
Telephone Number	:	210-614-3737
Fax Number	:	210-614-3147

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/08/2007

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