Provider Demographics
NPI:1134323231
Name:MAURICE S GROSSMAN MD FACP PA
Entity Type:Organization
Organization Name:MAURICE S GROSSMAN MD FACP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:SIDNEY
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-853-7301
Mailing Address - Street 1:1001 LOUISIANA AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2899
Mailing Address - Country:US
Mailing Address - Phone:361-853-7301
Mailing Address - Fax:361-853-0835
Practice Address - Street 1:1001 LOUISIANA AVE STE 307
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2899
Practice Address - Country:US
Practice Address - Phone:361-853-7301
Practice Address - Fax:361-853-0835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC3062173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031283701Medicaid
TX00Z178Medicare PIN
TX031283701Medicaid