Provider Demographics
NPI:1992384648
Name:GROMER, REX COLEMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:REX
Middle Name:COLEMAN
Last Name:GROMER
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 1:2 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-3416
Mailing Address - Country:US
Mailing Address - Phone:920-246-3543
Mailing Address - Fax:
Practice Address - Street 1:2 LAKE RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-3416
Practice Address - Country:US
Practice Address - Phone:920-246-3543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18738-20207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology