Provider Demographics
NPI:1326006727
Name:GROGAN, JOHN HENRY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HENRY
Last Name:GROGAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3851
Mailing Address - Country:US
Mailing Address - Phone:828-267-1916
Mailing Address - Fax:828-267-1922
Practice Address - Street 1:912 2ND ST NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3851
Practice Address - Country:US
Practice Address - Phone:828-267-1916
Practice Address - Fax:828-267-1922
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC430213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890804EMedicaid
NC0804EOtherBLUE CROSS BLUE SHIELD
NC2433609AMedicare ID - Type Unspecified
NC0804EOtherBLUE CROSS BLUE SHIELD