Organization
KEITH MARK GROSS MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH GROSS MD (OWNER)
(909) 335-8638
Entity
Organization
Contact information
Practice address
15247 11TH ST, SUITE 400, VICTORVILLE, CA 92395-3727
(909) 335-8638
(909) 335-8644
Mailing address
PO BOX 51197, DEPT 1401, LOS ANGELES, CA 90051-5497
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G63544
CA
Other
Enumeration date
12/26/2006
Last updated
01/17/2008
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