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General NPI Number Information
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NPI Number | 1548680622
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Entity Type | Individual
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Provider Name | KYLE GROOMS M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/16/2014
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Last Update Date | 03/27/2023
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Provider Practice Location Address
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Address Line | 267 N CANYON DR
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City | GOODING
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State | ID
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Zip | 83330-5500
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Country | US
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Telephone | 208-329-0345
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Fax |
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Provider Business Mailing Address
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Address Line | 195 EASTERN BLVD STE 200
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City | GLASTONBURY
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State | CT
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Zip | 06033-4353
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Country | US
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Telephone | 918-616-5409
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 62312
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | 62312
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | 62312
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License Number State | CT
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