Provider Demographics
NPI:1255625687
Name:ERIC GRASSER MD LLC
Entity type:Organization
Organization Name:ERIC GRASSER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:GRASSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-453-3756
Mailing Address - Street 1:1925 ASPEN DR STE 502A
Mailing Address - Street 2:
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 STE 502A
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-0151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMAAA1077OtherMEDICARE PTAN
NM68576358Medicaid