Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Theodore Gross

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1922531508

Theodore Gross is a Student in an Organized Health Care Education/Training Program in Fruitland, Idaho. Licensed in Idaho. Registered with an NPI since 2017.

Licensed in
ID
In the registry since
2017
Specialties on file
2

Practice location Address checks out

1100 NW 12th St
Fruitland, ID 83619-5040
Phone: (208) 452-6556
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X · Licence M-15894 (ID)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1922531508
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 10, 2017
Last updated in NPPESAugust 5, 2025
Certification dateAugust 5, 2025
Mailing address1100 Nw 12th St, Fruitland, ID 83619-5040

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