MEDICARE: JAMES RUSSELL GRUA 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	180796-1205	UT

General Provider Information

NPI Number	:	1134159288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES RUSSELL GRUA M.D.

Provider Business Mailing Address
First Line	:	2965 W 3500 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-3602
Country	:	US
Telephone Number	:	801-965-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2965 W 3500 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-3602
Country	:	US
Telephone Number	:	801-965-3600
Fax Number	:

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	02/24/2026

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