Provider Demographics
NPI:1992838007
Name:GROSSAN, MURRAY (MD)
Entity Type:Individual
Prefix:
First Name:MURRAY
Middle Name:
Last Name:GROSSAN
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 1:8631 W 3RD ST
Mailing Address - Street 2:SUITE 440E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5901
Mailing Address - Country:US
Mailing Address - Phone:310-657-7704
Mailing Address - Fax:310-652-9906
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:SUITE 440E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-657-7704
Practice Address - Fax:310-652-9906
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC14894207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWC14894AMedicare PIN
CAA30535Medicare UPIN