Healthcare Provider Details

I. General information

NPI: 1124215074
Provider Name (Legal Business Name): RAYMON GROGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DIVISADERO ST # C347 BOX 1674
SAN FRANCISCO CA
94115-3066
US

IV. Provider business mailing address

ONE BAYLOR PLAZA MS: BCM 390
HOUSTON TX
77030
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-7205
  • Fax:
Mailing address:
  • Phone: 713-798-2788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA96280
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberS3980
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number46258
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberS3980
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: