Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | H3063 | TX |
NPI | 1245290501 |
---|---|
Provider Name | Dr. Peter C. Grothaus |
First Address | Dallas, TX 75284-7408 |
Second Address | Temple, TX 76508-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 13/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1358574-03 | (05) | TX |
240006948 | RR/MEDICARE (01) | TX |
807643 | BLUE SHIELD (01) | TX |
E43868 | (02) | TX |