Basic Information
| Provider Information | |||||||||
| NPI: | 1336119577 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GROSS | ||||||||
| FirstName: | STUART | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1585 MALLORY LN STE 205 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370273035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7314000411 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 RAWLS DR STE 1500 | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396482878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016804599 | ||||||||
| FaxNumber: | 6016804585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2006 | ||||||||
| LastUpdateDate: | 05/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 51029 | TN | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP2900X | 19518 | MS | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.