MEDICARE: DR. JOHN W. GROGAN JR. PHD

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	106H00000X	Marriage & Family Therapist	108	CO

General Provider Information

NPI Number	:	1992822472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN W. GROGAN JR. PHD

Provider Business Mailing Address
First Line	:	1302 S SHIELDS ST
Second Line	:	SUITE A2-2
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-4801
Country	:	US
Telephone Number	:	970-213-1904
Fax Number	:

Provider Business Practice Location Address
First Line	:	1302 S SHIELDS ST
Second Line	:	SUITE A2-2
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-4801
Country	:	US
Telephone Number	:	970-213-1904
Fax Number	:

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	01/14/2012

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