MEDICARE: GARY L GRASMICK M.D.

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
1	207Q00000X	Family Medicine Physician	DR.0038232	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225011133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY L GRASMICK M.D.

Provider Business Mailing Address
First Line	:	5450 WESTERN AVE STE B
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-2709
Country	:	US
Telephone Number	:	303-415-5816
Fax Number	:	303-293-0625

Provider Business Practice Location Address
First Line	:	101 ERIE PKWY, STE 201C
Second Line	:
City	:	ERIE
State	:	CO
Zip	:	80516-4072
Country	:	US
Telephone Number	:	303-415-5816
Fax Number	:	303-293-0625

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	02/11/2020

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