Provider Demographics
NPI:1992065460
Name:GROTHAUS, REUBEN JAMES (DO)
Entity type:Individual
Prefix:
First Name:REUBEN
Middle Name:JAMES
Last Name:GROTHAUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 GAGE BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:3950 KEENE RD
Practice Address - Street 2:KADLEC CLINIC WEST RICHLAND PRIMARY CARE
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353
Practice Address - Country:US
Practice Address - Phone:509-942-3130
Practice Address - Fax:509-628-8335
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA71686207Q00000X
390200000X
WAOP60536083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program