Provider Demographics
NPI:1588757520
Name:WILLIAM GROSS, DPM, PA
Entity type:Organization
Organization Name:WILLIAM GROSS, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-345-0607
Mailing Address - Street 1:6499 38TH AVE N STE C2
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1650
Mailing Address - Country:US
Mailing Address - Phone:727-345-0607
Mailing Address - Fax:727-345-4309
Practice Address - Street 1:6499 38TH AVE N
Practice Address - Street 2:SUITE C-2
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1656
Practice Address - Country:US
Practice Address - Phone:727-345-0607
Practice Address - Fax:727-345-4309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO6000090640213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1609896737OtherTYPE 1 NPI NUMBER
FLP00349330OtherRAILROAD MEDICARE PALMETTO GBA
FL340593100Medicaid
FL6052160001Medicare NSC
FL1609896737OtherTYPE 1 NPI NUMBER
FL65346YMedicare PIN