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General NPI Number Information
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NPI Number | 1487759825
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Entity Type | Individual
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Provider Name | GEORGE WILLIAM GROTH IV M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6037 LA GRANADA SUITE C
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City | RANCHO SANTA FE
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State | CA
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Zip | 92067
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Country | US
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Telephone | 858-756-2116
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Fax | 858-756-4142
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Provider Business Mailing Address
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Address Line | PO BOX 950 6037 LA GRANADA, STE C
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City | RANCHO SANTA FE
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State | CA
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Zip | 92067
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Country | US
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Telephone | 858-756-2116
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Fax | 858-756-4142
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G38045
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License Number State | CA
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