Provider Demographics
NPI:1043244239
Name:DAWN M GROTEN MD IN
Entity Type:Organization
Organization Name:DAWN M GROTEN MD IN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GROTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-255-8825
Mailing Address - Street 1:3212 JEFFERSON ST
Mailing Address - Street 2:#196
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3436
Mailing Address - Country:US
Mailing Address - Phone:707-255-8825
Mailing Address - Fax:707-252-9325
Practice Address - Street 1:1118 AUSTIN WAY
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-4225
Practice Address - Country:US
Practice Address - Phone:707-253-2653
Practice Address - Fax:707-253-1297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54516207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACH462AMedicare PIN