Provider Demographics
NPI:1528146487
Name:GROTZ, R. THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:R.
Middle Name:THOMAS
Last Name:GROTZ
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 1:1700 CALIFORNIA ST
Mailing Address - Street 2:SUITE 520
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4586
Mailing Address - Country:US
Mailing Address - Phone:415-447-2988
Mailing Address - Fax:415-447-7361
Practice Address - Street 1:1700 CALIFORNIA ST
Practice Address - Street 2:SUITE 520
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4586
Practice Address - Country:US
Practice Address - Phone:415-447-2988
Practice Address - Fax:415-447-7361
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33148207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC04196Medicare UPIN
CA00G331480Medicare ID - Type Unspecified