Provider Demographics
NPI:1750381075
Name:GROSSMAN, MAURICE S (MD)
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:S
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 1:1001 LOUISIANA AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2899
Mailing Address - Country:US
Mailing Address - Phone:361-853-7301
Mailing Address - Fax:361-853-0835
Practice Address - Street 1:1001 LOUISIANA AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2899
Practice Address - Country:US
Practice Address - Phone:361-853-7301
Practice Address - Fax:361-853-0835
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC3062173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0312837-01Medicaid
TX74-1835563OtherTAX ID
TX0312837-01Medicaid
TXC16343Medicare UPIN