Healthcare Provider Details

I. General information

NPI: 1356646590
Provider Name (Legal Business Name): ERIC GROSSMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 HOLLISTER AVE STE 250
SANTA BARBARA CA
93111-2466
US

IV. Provider business mailing address

5333 HOLLISTER AVE
SANTA BARBARA CA
93111-2341
US

V. Phone/Fax

Practice location:
  • Phone: 805-879-4240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2014-01197
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberA157157
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: