Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 67216 | WI |
Y | 207T00000X | Neurosurgeon | R8364 | TX |
NPI | 1053832527 |
---|---|
Provider Name | Dr. Joey Kevin Grochmal |
First Address | Lubbock, TX 79407-3545 |
Second Address | Lubbock, TX 79415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2017 |
Last Update Date | 07/12/2021 |