Healthcare Provider Details

I. General information

NPI: 1750381075
Provider Name (Legal Business Name): MAURICE S GROSSMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LOUISIANA AVE SUITE 307
CORPUS CHRISTI TX
78404-2899
US

IV. Provider business mailing address

1001 LOUISIANA AVE SUITE 307
CORPUS CHRISTI TX
78404-2899
US

V. Phone/Fax

Practice location:
  • Phone: 361-853-7301
  • Fax: 361-853-0835
Mailing address:
  • Phone: 361-853-7301
  • Fax: 361-853-0835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberC3062
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: