Provider Demographics
NPI:1194085654
Name:GROGAN, RONALD G (MS)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:G
Last Name:GROGAN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-2923
Mailing Address - Country:US
Mailing Address - Phone:307-399-5553
Mailing Address - Fax:
Practice Address - Street 1:210 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-2923
Practice Address - Country:US
Practice Address - Phone:307-399-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator