Healthcare Provider Details

I. General information

NPI: 1699786608
Provider Name (Legal Business Name): DAVID LAWRENCE DE GROH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 COLUMBUS AVE
SANDUSKY OH
44870-5557
US

IV. Provider business mailing address

3416 COLUMBUS AVE
SANDUSKY OH
44870-5557
US

V. Phone/Fax

Practice location:
  • Phone: 419-625-7350
  • Fax: 419-625-6660
Mailing address:
  • Phone: 419-625-7350
  • Fax: 419-625-6660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.002813
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: