Individual
DR. MARK LAND GROSSETETE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
117 CAMINO DE VIDA STE 300, SANTA ROSA, NM 88435
(575) 472-4311
(575) 472-4313
Mailing address
117 CAMINO DE VIDA STE 300, SANTA ROSA, NM 88435-2267
(575) 472-4311
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
MD2017-0779
NM
207LA0401X
Addiction Medicine (Anesthesiology) Physician
MD2017-0779
NM
207R00000X
Internal Medicine Physician
MD2017-0779
NM
2084N0400X
Neurology Physician
Primary
MD2017-0779
NM
208VP0000X
Pain Medicine Physician
MD2017-0779
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
NM
Other
Enumeration date
03/17/2013
Last updated
01/08/2024
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