Individual
RUSSELL J GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1995 HIGHWAY 51 S, SUITE 203, COVINGTON, TN 38019-3635
(901) 475-5422
(901) 475-5595
Mailing address
965 RIDGE LAKE BLVD, SUITE 103, MEMPHIS, TN 38120-9401
(901) 227-4068
(901) 227-8591
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
31869
CA
208600000X
Surgery Physician
A31869
CA
2086S0129X
Vascular Surgery Physician
Primary
40003
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0989653
CIGNA
—
05
—
1507224
—
TN
01
—
4167965
BCBS TN
TN
01
—
42359
MEDICAID TLC
TN
Enumeration date
05/01/2006
Last updated
01/29/2014
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