Provider Demographics
NPI:1932157716
Name:GROGGEL, GERALD C (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:C
Last Name:GROGGEL
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 1:931 HIGHLAND BLVD STE 3260
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6912
Mailing Address - Country:US
Mailing Address - Phone:406-522-2410
Mailing Address - Fax:406-556-5198
Practice Address - Street 1:931 HIGHLAND BLVD- SUITE 3260
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:406-522-2410
Practice Address - Fax:406-556-5198
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19770207RN0300X
MT12522207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47078557528Medicaid
NED20247Medicare UPIN
NE47078557528Medicaid