MEDICARE: CHRISTOPHER GROBERG PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	13641879-1206	UT

General Provider Information

NPI Number	:	1104556125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER GROBERG PA

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:	801-400-6240
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 N 500 E STE 320
Second Line	:
City	:	LOGAN
State	:	UT
Zip	:	84341-2462
Country	:	US
Telephone Number	:	435-716-2200
Fax Number	:	435-716-2220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2022
Last Update Date	:	02/27/2024

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Directions to “ CHRISTOPHER GROBERG PA” Practice Location

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