Provider Demographics
NPI:1427347764
Name:GRONER, MORDECHAI (MD)
Entity type:Individual
Prefix:
First Name:MORDECHAI
Middle Name:
Last Name:GRONER
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 1:3525 ENSIGN RD NE STE F
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5065
Mailing Address - Country:US
Mailing Address - Phone:360-493-4001
Mailing Address - Fax:360-438-2026
Practice Address - Street 1:3525 ENSIGN RD NE STE F
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5065
Practice Address - Country:US
Practice Address - Phone:360-493-4001
Practice Address - Fax:360-438-2026
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036148227207RI0200X
WAMD61151650207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease