Provider Demographics
NPI:1437599297
Name:GROOM, MARA M (DO)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:M
Last Name:GROOM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3725
Mailing Address - Country:US
Mailing Address - Phone:712-294-5000
Mailing Address - Fax:712-294-5091
Practice Address - Street 1:2501 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3725
Practice Address - Country:US
Practice Address - Phone:712-294-5000
Practice Address - Fax:712-294-5091
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-9859207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine