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Individual

STEVEN PAUL GROSS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
12000 STONE LAKE ROAD, DULCE, NM 87528
(575) 759-7232
(575) 759-7294
Mailing address
PO BOX 187, DULCE, NM 87528-0187
(575) 759-7232
(575) 759-7294

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
84-44
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00032607
NM
01
8HL709
MEDICARE PROVIDER #
NM
01
HSZ196
MEDICARE PART B
NM
05
K3526
NM
Enumeration date
09/20/2006
Last updated
09/24/2010
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