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NPI Code Detail

MEDICARE: CHRISTOPHER GROBERG PA

MEDICARE: CHRISTOPHER GROBERG PA
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
1363A00000XPhysician Assistant13641879-1206UT

General Provider Information

NPI Number : 1104556125
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER GROBERG PA
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number : 801-400-6240
Fax Number :
Provider Business Practice Location Address
First Line : 1300 N 500 E STE 320
Second Line :
City : LOGAN
State : UT
Zip : 84341-2462
Country : US
Telephone Number : 435-716-2200
Fax Number : 435-716-2220
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2022
Last Update Date : 02/27/2024

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1821005349 — DR. DAVID T CRAGUN MD
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1316329220 — DR. JACOB DOUGLAS ANDERSON DNP
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Directions to “ CHRISTOPHER GROBERG PA” Practice Location

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