Provider Demographics
NPI:1982748232
Name:GROSSERODE, ROBERT STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:STEPHEN
Last Name:GROSSERODE
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 1:3747 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6101
Mailing Address - Country:US
Mailing Address - Phone:925-754-2300
Mailing Address - Fax:
Practice Address - Street 1:3747 SUNSET LN
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6101
Practice Address - Country:US
Practice Address - Phone:925-754-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51975207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G519750Medicaid
CA00G519750Medicaid
CA00G519750Medicare ID - Type Unspecified