Provider Demographics
NPI:1184787491
Name:GRONER, JOHN B (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:GRONER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4309 W 27TH PL STE 202
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-2908
Mailing Address - Country:US
Mailing Address - Phone:509-591-4966
Mailing Address - Fax:509-396-5033
Practice Address - Street 1:4309 W 27TH PL STE 202
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-2908
Practice Address - Country:US
Practice Address - Phone:509-591-4966
Practice Address - Fax:509-396-5033
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1566212081N0008X, 2081P2900X
WAMD000494372081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR170169Medicare PIN