Provider Demographics
NPI:1396733630
Name:GLOSS, ERIC JOHN (DO)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JOHN
Last Name:GLOSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1376
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577
Mailing Address - Country:US
Mailing Address - Phone:919-934-8171
Mailing Address - Fax:919-989-7297
Practice Address - Street 1:509 N BRIGHT LEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577
Practice Address - Country:US
Practice Address - Phone:919-934-8171
Practice Address - Fax:919-989-7297
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010315207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5101010315OtherCONTROLLED SUBSTANCE
MI4553986Medicaid
MI4553986Medicaid
G44883016Medicare ID - Type Unspecified