Robert O. Gross, D.O.
Individual provider Active NPI General Practice Physician · Clear Lake, IA
NPI 1033200795 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1033200795
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 01767 (IA)
- Practice address
- 800 1St Ave N
Suite #1
Clear Lake, IA 50428-1725 - Phone
- (641) 357-2141
- Fax
- (641) 357-4315
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01767 | IA | MD | General Practice Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 01767 | IA | Yes |
Addresses
Primary practice location
800 1St Ave N
Suite #1
Clear Lake, IA 50428-1725
Mailing address
PO Box 145
Clear Lake, IA 50428-0145
Phone (641) 357-2141
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 16725 | Other | IA | WELLMARK |
Other providers in Clear Lake, IA
- Alexis Friend
- Henry L Goetz Jr.
- Traci Goll
- Hailey Sue Elizabeth Grell
- Michelle Gremmer
- Makenzie Jo Gudmonson
- Shania M Hagen
- Handicap Village
- Handicap Village
- Handicap Village
All providers in Clear Lake, IA · General Practice Physician in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.