| Doctor Name: | DR. EVAN H GROSS |
| NPI Number: | 1023140423 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | 25MD00289200 |
| Business Practice Address: | 146 Lakeview Dr S Gibbsboro, NJ - 080261018 |
| Business Phone Number: | 8564354002 |
| Business Fax Number: | |
| Mailing Address: | 146 Lakeview Dr S, GIBBSBORO |
| State: | NJ |
| Postal Code: | 080261018 |
| Phone Number: | 8564354002 |
| Fax Number: | |
| NPI Enumeration Date: | 03/12/2007 |
| NPI Last Update Date: | 09/10/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 25MD00289200 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |