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NPI Code Detail

MEDICARE: GEORGE T GROSSBERG MD

MEDICARE: GEORGE T GROSSBERG MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0805XGeriatric Psychiatry PhysicianR6957MO
22084P0800XPsychiatry PhysicianR6957MO

General Provider Information

NPI Number : 1033135991
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEORGE T GROSSBERG MD
Provider Business Mailing Address
First Line : 1438 S GRAND BLVD
Second Line : PROVIDER ENROLLMENT
City : SAINT LOUIS
State : MO
Zip : 63104-1027
Country : US
Telephone Number : 314-977-4825
Fax Number :
Provider Business Practice Location Address
First Line : 1438 S GRAND BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63104-1027
Country : US
Telephone Number : 314-977-4829
Fax Number : 314-268-5494
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2006
Last Update Date : 01/12/2021

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Directions to “ GEORGE T GROSSBERG MD” Practice Location

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