Individual
GAVIN GROSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
15946 N BULLARD AVE, SURPRISE, AZ 85374-8844
(816) 382-5753
Mailing address
15946 N BULLARD AVE, SURPRISE, AZ 85374-8844
(816) 382-5753
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
1588
AZ
Other
Enumeration date
04/17/2018
Last updated
04/17/2018
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