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NPI Code Detail

MEDICARE: BRIAN GROGAN MD

MEDICARE: BRIAN GROGAN MD
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
1207V00000XObstetrics & Gynecology Physician21573AZ
2207V00000XObstetrics & Gynecology PhysicianG63543CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235218439
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN GROGAN MD
Provider Business Mailing Address
First Line : 6153 CAMINITO DEL OESTE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92111-6822
Country : US
Telephone Number : 928-446-1819
Fax Number : 928-782-7473
Provider Business Practice Location Address
First Line : 6973 LINDA VISTA RD
Second Line :
City : SAN DIEGO
State : CA
Zip : 92111-6342
Country : US
Telephone Number : 858-279-0925
Fax Number : 858-633-4680
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2006
Last Update Date : 10/26/2022

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