Provider Demographics
NPI:1144108028
Name:GROSSMAN, DAVID JOSHUA
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOSHUA
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 GREAT NORTHERN AVE APT K34
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1719
Mailing Address - Country:US
Mailing Address - Phone:315-761-6369
Mailing Address - Fax:
Practice Address - Street 1:2200 GREAT NORTHERN AVE APT K34
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1719
Practice Address - Country:US
Practice Address - Phone:315-761-6369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program