Individual
JEFFREY GLENN GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7620 TRENHOLM ROAD EXT, COLUMBIA, SC 29223-1718
(803) 736-7200
(803) 736-2116
Mailing address
7620 TRENHOLM ROAD EXT, COLUMBIA, SC 29223-1718
(803) 736-7200
(803) 736-2116
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
14505
SC
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
14505
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
TL2900
—
SC
Enumeration date
08/02/2005
Last updated
08/04/2017
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