Provider Demographics
NPI:1225011133
Name:GRASMICK, GARY L (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:GRASMICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5450 WESTERN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-5816
Mailing Address - Fax:303-293-0625
Practice Address - Street 1:101 ERIE PKWY, STE 201C
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-4072
Practice Address - Country:US
Practice Address - Phone:303-415-5816
Practice Address - Fax:303-293-0625
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0038232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56882033Medicaid
CO56882033Medicaid
COH63909Medicare UPIN