Provider Demographics
NPI:1669935631
Name:GROGAN, RILEY SEAN (MD)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:SEAN
Last Name:GROGAN
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:PO BOX 31001
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-4110
Mailing Address - Country:US
Mailing Address - Phone:406-329-5828
Mailing Address - Fax:406-329-5864
Practice Address - Street 1:500 W BROADWAY ST FL 4BB
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4008
Practice Address - Country:US
Practice Address - Phone:406-329-5828
Practice Address - Fax:406-329-5864
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2025-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI74548-20208600000X
MTMED-PHYS-LIC-156377208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery