Provider Demographics
NPI:1962474635
Name:GRASSER, ERIC L (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:L
Last Name:GRASSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1925 ASPEN DR
Mailing Address - Street 2:STE 502A
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5559
Mailing Address - Country:US
Mailing Address - Phone:505-983-9878
Mailing Address - Fax:505-629-1095
Practice Address - Street 1:1925 ASPEN DR
Practice Address - Street 2:STE 502A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5559
Practice Address - Country:US
Practice Address - Phone:505-983-9878
Practice Address - Fax:505-629-1095
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2023-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM2003-0151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH81817Medicare UPIN