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1477565026

NPI Code Detail

MEDICARE: MR. WILLIAM ANTHONY GROMKO M.D.

MEDICARE: MR. WILLIAM ANTHONY GROMKO M.D.

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	207Q00000X	Family Medicine Physician	14461	WA
2	207Q00000X	Family Medicine Physician	66750	MN
3	207Q00000X	Family Medicine Physician	MD204079	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	147208	OTHER	WA	WORKERS COMPENSATION
2	7280GR	OTHER	WA	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	080168652	OTHER	WA	PALMETTO GBA
5	610278200	OTHER	WA	U.S. DEPT. OF LABOR
6	912107280985030000	OTHER	WA	TRICARE

General Provider Information

NPI Number	:	1477565026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM ANTHONY GROMKO M.D.

Provider Business Mailing Address
First Line	:	17055 RUBEN LN
Second Line	:
City	:	SANDY
State	:	OR
Zip	:	97055-9276
Country	:	US
Telephone Number	:	503-668-8002
Fax Number	:

Provider Business Practice Location Address
First Line	:	17055 RUBEN LN
Second Line	:
City	:	SANDY
State	:	OR
Zip	:	97055-9276
Country	:	US
Telephone Number	:	503-668-8002
Fax Number	:	503-668-5246

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	05/11/2021

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Directions to “ MR. WILLIAM ANTHONY GROMKO M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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