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General NPI Number Information
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NPI Number | 1124037650
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Entity Type | Individual
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Provider Name | ROBERT JEFF GRONDEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 98 POPLAR ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-1758
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Country | US
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Telephone | 208-273-7700
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Fax | 702-565-8898
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Provider Business Mailing Address
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Address Line | 98 POPLAR ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-1758
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Country | US
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Telephone | 208-273-7700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | M16347
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | M16347
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License Number State | ID
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