Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 7118 | NH |
NPI | 1225106818 |
---|---|
Provider Name | John M Grobman |
First Address | Gilford, NH 03249-6580 |
Second Address | Gilford, NH 03249-6580 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00000464 | (05) | NH |
D45500 | (02) | NH |