Individual
CARL GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
540 JETT DR, JACKSON, KY 41339-9622
(606) 666-6000
Mailing address
43 SPLIT POPLAR FORK RD, BOONEVILLE, KY 41314-7070
(606) 568-7980
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1135824
KY
Other
Enumeration date
10/21/2016
Last updated
10/21/2016
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