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NPI Code Detail

MEDICARE: DALLAS GRASSBAUGH

MEDICARE: DALLAS GRASSBAUGH
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
1171M00000XCase Manager/Care CoordinatorNM

General Provider Information

NPI Number : 1457840092
Entity Type Code : Individual
Provider Name (Legal Business Name) : DALLAS GRASSBAUGH
Provider Business Mailing Address
First Line : 400 GOLD AVE SW STE 1300W
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87102-3283
Country : US
Telephone Number : 505-630-3328
Fax Number :
Provider Business Practice Location Address
First Line : 400 GOLD AVE SW STE 1300W
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87102-3283
Country : US
Telephone Number : 505-630-3328
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2018
Last Update Date : 12/08/2025

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Directions to “ DALLAS GRASSBAUGH ” Practice Location

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