Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 10405 | TX |
Y | 213EG0000X | General Practice | 10405 | TX |
NPI | 1003820390 |
---|---|
Provider Name | Ronald E. Groba |
First Address | Friendswood, TX 77546-4543 |
Second Address | Friendswood, TX 77546-4543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2006 |
Last Update Date | 08/07/2007 |