Individual
KEITH MARK GROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12550 HESPERIA RD, 400, VICTORVILLE, CA 92395
(909) 335-8638
(909) 335-8644
Mailing address
PO BOX 848950, LOS ANGELES, CA 90084-8950
(909) 335-8638
(909) 335-8644
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
7006
NV
207N00000X
Dermatology Physician
Primary
G63544
CA
Other
Enumeration date
05/26/2006
Last updated
06/28/2018
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