Individual
THEODORE GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1100 NW 12TH ST, FRUITLAND, ID 83619-5040
(208) 452-6556
Mailing address
1100 NW 12TH ST, FRUITLAND, ID 83619-5040
(208) 452-6556
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M-15894
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/10/2017
Last updated
08/05/2025
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