Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | G046706 | CA |
NPI | 1134260110 |
---|---|
Provider Name | Dr. Thomas James Grogan JR. |
First Address | Los Angeles, CA 90025-1503 |
Second Address | Los Angeles, CA 90025-1503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2007 |
Last Update Date | 17/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A92669 | (02) |