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Organization

RICHARD A GROSSMAN

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. MELODY A WARREN (BILLER)
(970) 259-7679
Entity
Organization

Contact information

Practice address
1 MERCADO ST STE 105, DURANGO, CO 81301-7311
(970) 259-7679
(970) 382-0784
Mailing address
PO BOX 2674, DURANGO, CO 81302-2674
(970) 259-7679
(970) 382-0784

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
20447
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
04016457
CO
Enumeration date
07/10/2008
Last updated
07/10/2008
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