Provider Demographics
NPI:1154495216
Name:GRUTZMACHER, RICHARD D (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:GRUTZMACHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1515 RIVER PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4610
Mailing Address - Country:US
Mailing Address - Phone:916-649-1515
Mailing Address - Fax:916-649-1516
Practice Address - Street 1:1515 RIVER PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4610
Practice Address - Country:US
Practice Address - Phone:916-649-1515
Practice Address - Fax:916-649-1516
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG351040207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G351040Medicaid
CAA46216Medicare UPIN