Provider Demographics
NPI:1346224169
Name:GROSSMAN, DANIEL ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROBERT
Last Name:GROSSMAN
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 1:7625 W 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4567
Mailing Address - Country:US
Mailing Address - Phone:303-254-7464
Mailing Address - Fax:303-252-9875
Practice Address - Street 1:7625 W 92ND AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-4567
Practice Address - Country:US
Practice Address - Phone:303-254-7464
Practice Address - Fax:303-252-9875
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41579207Q00000X
CO27879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16475721Medicaid
WI41579OtherLICENSE
CO513142OtherMEDICARE GROUP NUMBER
CO16475721Medicaid
CO306085YT7ZMedicare PIN
CO513142OtherMEDICARE GROUP NUMBER