Provider Demographics
NPI:1235366709
Name:GRONBECK, DONALD ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ALEXANDER
Last Name:GRONBECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 DAYTON ST UNIT 106
Mailing Address - Street 2:
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-1778
Mailing Address - Country:US
Mailing Address - Phone:937-767-1088
Mailing Address - Fax:937-767-1022
Practice Address - Street 1:888 DAYTON ST UNIT 106
Practice Address - Street 2:
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-1778
Practice Address - Country:US
Practice Address - Phone:937-767-1088
Practice Address - Fax:937-767-1022
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.120593207QA0401X, 207Q00000X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program