Provider Demographics
NPI:1487759825
Name:GROTH, GEORGE WILLIAM IV (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WILLIAM
Last Name:GROTH
Suffix:IV
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950
Mailing Address - Street 2:6037 LA GRANADA, STE C
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067
Mailing Address - Country:US
Mailing Address - Phone:858-756-2116
Mailing Address - Fax:858-756-4142
Practice Address - Street 1:6037 LA GRANADA
Practice Address - Street 2:SUITE C
Practice Address - City:RANCHO SANTA FE
Practice Address - State:CA
Practice Address - Zip Code:92067
Practice Address - Country:US
Practice Address - Phone:858-756-2116
Practice Address - Fax:858-756-4142
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG38045207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB56813Medicare UPIN