Provider Demographics
NPI:1295754851
Name:GROSSFELD, GARY DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:DAVID
Last Name:GROSSFELD
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 1:1000 S. ELISEO DR.
Mailing Address - Street 2:SUITE #201
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904
Mailing Address - Country:US
Mailing Address - Phone:415-461-4000
Mailing Address - Fax:
Practice Address - Street 1:1000 S. ELISEO DR.
Practice Address - Street 2:SUITE #201
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904
Practice Address - Country:US
Practice Address - Phone:415-461-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72165208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G721651OtherBLUE SHIELD
CAG38247Medicare UPIN
CA00G721651Medicare ID - Type UnspecifiedMEDICARE