Healthcare Provider Details

I. General information

NPI: 1699965442
Provider Name (Legal Business Name): RONALD THOMAS GRONDIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 6TH AVE STE 200
TACOMA WA
98405-4682
US

IV. Provider business mailing address

915 6TH AVE STE 200
TACOMA WA
98405-4682
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-7277
  • Fax:
Mailing address:
  • Phone: 253-403-7277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number35092472
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD60440903
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60440903
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: