Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 35.120593 | OH |
N | 207QA0401X | Family Doctor - Addiction Medicine | 35.120593 | OH |
NPI | 1235366709 |
---|---|
Provider Name | Dr. Donald Alexander Gronbeck |
First Address | Yellow Springs, OH 45387-1778 |
Second Address | Yellow Springs, OH 45387-1778 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2009 |
Last Update Date | 27/04/2021 |