Individual
KENNETH RANDELL GROSSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
580 COLLINS DR, MERCED, CA 95348-3121
(209) 383-0989
(209) 383-6836
Mailing address
580 COLLINS DR, MERCED, CA 95348-3121
(209) 383-0989
(209) 383-6836
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
G50711
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0087430
—
CA
Enumeration date
03/27/2006
Last updated
07/06/2009
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