Individual
DR. MAJOR RYAN GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2620 WHEATON WAY, BREMERTON, WA 98310-3335
(360) 377-3923
(360) 373-4988
Mailing address
2620 WHEATON WAY, BREMERTON, WA 98310-3319
(360) 377-3923
(360) 373-4988
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00032849
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136044
LABOR & INDUSTRIES
WA
01
—
1665GR
REGENCE
WA
05
—
8197154
—
WA
01
—
91114366510
KPS HEALTHPLANS
WA
01
—
91114366598310A010
TRICARE
WA
01
—
MD00032849
MD LICENSE CREDENTIAL NUMBER
WA
Enumeration date
10/04/2005
Last updated
04/21/2021
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