Provider Demographics
NPI:1609896737
Name:GROSS, WILLIAM (DPM)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:GROSS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-0002411213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340593100Medicaid
FL1588757520OtherTYPE 2 NPI
FLP00349330OtherRAILROAD MEDICARE
FL65346OtherBLUE CROSS
FL65346YMedicare PIN
FLU50418Medicare UPIN
FL6052160001Medicare NSC