Provider Demographics
NPI:1548348642
Name:GROSSMAN, RICHARD F (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:F
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1199 BUSH ST
Mailing Address - Street 2:SUITE 390
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5999
Mailing Address - Country:US
Mailing Address - Phone:415-800-8371
Mailing Address - Fax:415-655-9219
Practice Address - Street 1:1199 BUSH ST
Practice Address - Street 2:SUITE 390
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5999
Practice Address - Country:US
Practice Address - Phone:415-800-8371
Practice Address - Fax:415-655-9219
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG70330208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G703300Medicaid
CA00G703300Medicaid
F96151Medicare UPIN