Provider Demographics
NPI:1023001757
Name:GROSSHEIM, ROBERT L (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:GROSSHEIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 E 30TH
Mailing Address - Street 2:BLDG D STE 101
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-8990
Mailing Address - Country:US
Mailing Address - Phone:505-327-1400
Mailing Address - Fax:505-564-3202
Practice Address - Street 1:2300 E 30TH
Practice Address - Street 2:BLDG D STE 101
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-8990
Practice Address - Country:US
Practice Address - Phone:505-327-1400
Practice Address - Fax:505-564-3202
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM73128207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00NM001137OtherBCBS
200013227OtherRAILROAD MEDICARE
NM73128OtherNEW MEXICO MEDICAL LICENS
NM11395Medicaid
NM11395Medicaid
D35678Medicare UPIN
200013227OtherRAILROAD MEDICARE