Provider Demographics
NPI:1114215365
Name:GROSSMAN, JULIE GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:GAIL
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:4103 RUSKIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-3548
Mailing Address - Country:US
Mailing Address - Phone:713-240-3609
Mailing Address - Fax:
Practice Address - Street 1:1475 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1002
Practice Address - Country:US
Practice Address - Phone:305-243-4902
Practice Address - Fax:305-243-4907
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1577492086X0206X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME157749OtherMEDICAL LICENSE