Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD6797 | ME |
NPI | 1114908415 |
---|---|
Provider Name | Dr. Philip Clarence Groce |
First Address | Union, ME 04862-4824 |
Second Address | Union, ME 04862-4824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 04/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008618 | ANTHEM (01) | ME |
011132479 | RR MEDICARE (01) | |
237410000 | (05) | ME |
C66570 | (02) |