Healthcare Provider Details

I. General information

NPI: 1114908415
Provider Name (Legal Business Name): PHILIP CLARENCE GROCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 APPLETON RD
UNION ME
04862-4824
US

IV. Provider business mailing address

321 APPLETON RD
UNION ME
04862-4824
US

V. Phone/Fax

Practice location:
  • Phone: 207-785-2969
  • Fax: 207-785-2960
Mailing address:
  • Phone: 207-785-2969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD6797
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: