Provider Demographics
NPI:1124037650
Name:GRONDEL, ROBERT JEFF (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JEFF
Last Name:GRONDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10561 JEFFREYS ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4266
Mailing Address - Country:US
Mailing Address - Phone:702-565-6565
Mailing Address - Fax:702-565-8898
Practice Address - Street 1:10561 JEFFREYS ST
Practice Address - Street 2:SUITE 230
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4266
Practice Address - Country:US
Practice Address - Phone:702-565-6565
Practice Address - Fax:702-565-8898
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7523207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019572Medicaid
NV200030368OtherRAILROAD MEDICARE
NVWQBDS03Medicare ID - Type Unspecified
NV0655010001Medicare NSC
NV002019572Medicaid