Individual
COLEMAN GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 27TH ST, STE 103, OAKLAND, CA 94612-3124
(510) 832-2663
Mailing address
PO BOX 20106, TAMPA, FL 33622-0106
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G69240
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G692400
BLUE SHIELD
CA
05
—
00G692400
—
CA
01
—
P00364640
RAILROAD MEDICARE
—
Enumeration date
07/10/2006
Last updated
12/23/2008
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