Robert E Grossman, MD
Individual provider Active NPI Family Medicine Physician · Hettinger, ND
NPI 1295821932 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1295821932
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 3459 (ND)
- Practice address
- 1000 Highway 12
Hettinger, ND 58639-7530 - Phone
- (701) 567-4561
- NPI assigned
- Oct 4, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3459 | ND | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 3459 | ND | Yes |
Addresses
Primary practice location
1000 Highway 12
Hettinger, ND 58639-7530
Mailing address
1100 Highway 12
Hettinger, ND 58639-7533
Phone (701) 567-4561
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0553917 | Medicaid | IA | |
| 12563 | Medicaid | ND | |
| 7776150 | Medicaid | SD | |
| 123993 | Other | ND | WORKER'S COMP |
| 45034068812 | Medicaid | NE | |
| 10772 | Other | ND | BLUE CROSS BLUE SHIELD OF |
| 25972 | Other | SIOUX VALLEY | |
| 3018140 | Medicaid | WA |
Other providers in Hettinger, ND
- Gary William Dewhirst
- Dr Gabbert Clinical Psychologist PLLC
- William C Elder
- Encompass Therapy LLC
- Seth Wayne Fisher
- Robert J Gustafson
- Susan K Hallen
- Suzan Jean Hanson
- Lynly J Hebert
- Jacquelyn Ann Hedstrom
All providers in Hettinger, ND · Family Medicine Physician in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.