Provider Demographics
NPI:1720035140
Name:GROMKE, GEORGE DIETER (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:DIETER
Last Name:GROMKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2914
Mailing Address - Country:US
Mailing Address - Phone:970-245-0484
Mailing Address - Fax:970-241-2803
Practice Address - Street 1:2020 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2914
Practice Address - Country:US
Practice Address - Phone:970-245-0484
Practice Address - Fax:970-241-2803
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32179207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01321793Medicaid
CO01321793Medicaid
F16840Medicare UPIN