Provider Demographics
NPI:1679729479
Name:GRASS GARCIA, EDUARD (MD)
Entity type:Individual
Prefix:
First Name:EDUARD
Middle Name:
Last Name:GRASS GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 498
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566-0498
Mailing Address - Country:US
Mailing Address - Phone:712-623-7240
Mailing Address - Fax:712-623-1654
Practice Address - Street 1:1400 SENATE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-1271
Practice Address - Country:US
Practice Address - Phone:712-623-7240
Practice Address - Fax:712-623-1654
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA37900208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA421102673OtherFEDERAL TAX ID NUMBER