Provider Demographics
NPI:1962690339
Name:EUGENE C GROEGER,M.D. A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:EUGENE C GROEGER,M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NUALA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ODONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-239-2300
Mailing Address - Street 1:2645 OCEAN AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1633
Mailing Address - Country:US
Mailing Address - Phone:415-239-2300
Mailing Address - Fax:
Practice Address - Street 1:2645 OCEAN AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1633
Practice Address - Country:US
Practice Address - Phone:415-239-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31287208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44711Medicare UPIN