Provider Demographics
NPI:1265448989
Name:GROSSMAN, RICHARD (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MERCADO ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7300
Mailing Address - Country:US
Mailing Address - Phone:970-382-8800
Mailing Address - Fax:970-382-0122
Practice Address - Street 1:1 MERCADO ST
Practice Address - Street 2:SUITE 105
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7300
Practice Address - Country:US
Practice Address - Phone:970-382-8800
Practice Address - Fax:970-382-0122
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM70-135207V00000X
CO20447207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology