Provider Demographics
NPI:1902890544
Name:GROSS, RONALD LEON (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:LEON
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
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 2020
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36533-2020
Mailing Address - Country:US
Mailing Address - Phone:713-376-7151
Mailing Address - Fax:
Practice Address - Street 1:411 N SECTION ST
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532
Practice Address - Country:US
Practice Address - Phone:251-990-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2018-06-11
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
TXG2976207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134601702Medicaid
TX2316335OtherBLUE LINK
TX134601703Medicaid
TX134601704Medicaid
TX82W286OtherBC/BS
TX2316335OtherBLUE LINK
TX82W286Medicare PIN
TX134601702Medicaid
TX134601704Medicaid
TX134601703Medicaid