Basic Information
| Provider Information | |||||||||
| NPI: | 1467492496 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GROSS | ||||||||
| FirstName: | LEE | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2975 BOBCAT VILLAGE CENTER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NORTH PORT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342884600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414239936 | ||||||||
| FaxNumber: | 9414269794 | ||||||||
| Practice Location | |||||||||
| Address1: | 2975 BOBCAT VILLAGE CENTER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NORTH PORT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342884600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414239936 | ||||||||
| FaxNumber: | 9414269794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 10/10/2011 | ||||||||
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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 | 207Q00000X | ME84648 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.