Provider Demographics
NPI:1922236470
Name:GROTH, MCGARRETT (DO)
Entity Type:Individual
Prefix:
First Name:MCGARRETT
Middle Name:
Last Name:GROTH
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 1:810 RAVEN HILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ATTCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002
Mailing Address - Country:US
Mailing Address - Phone:913-367-6675
Mailing Address - Fax:913-674-2023
Practice Address - Street 1:810 RAVEN HILL DRIVE
Practice Address - Street 2:
Practice Address - City:ATTCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002
Practice Address - Country:US
Practice Address - Phone:913-367-6675
Practice Address - Fax:913-674-2023
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-35645207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine