Provider Demographics
NPI:1164465019
Name:GROTE, DAVID J (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:GROTE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 HAMILTON BLVD
Mailing Address - Street 2:STE. 102
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-2425
Mailing Address - Country:US
Mailing Address - Phone:712-277-9370
Mailing Address - Fax:712-252-4733
Practice Address - Street 1:2930 HAMILTON BLVD
Practice Address - Street 2:STE. 102
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-2425
Practice Address - Country:US
Practice Address - Phone:712-277-9370
Practice Address - Fax:712-252-4733
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000844363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1164465019OtherMEDICARE INDIVIDUAL NPI
IAIB2763OtherMEDICARE GROUP PTAN
IA1417088907OtherWELLMARK GROUP NPI NUMBER
IADT7736OtherMEDICARE RR GROUP PTAN
IAIB2763004OtherMEDICARE INDIVIDUAL PTAN