Healthcare Provider Details

I. General information

NPI: 1144531955
Provider Name (Legal Business Name): ALICIA W. GROSSMANN, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 W PARMER LN SUITE 102
AUSTIN TX
78729-6801
US

IV. Provider business mailing address

6301 W PARMER LN SUITE 102
AUSTIN TX
78729-6801
US

V. Phone/Fax

Practice location:
  • Phone: 512-834-9999
  • Fax: 512-834-9998
Mailing address:
  • Phone: 512-834-9999
  • Fax: 512-834-9998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN1660
License Number StateTX

VIII. Authorized Official

Name: DR. ALICIA W. GROSSMANN
Title or Position: OWNER
Credential: M.D.
Phone: 512-834-9999