# MONTY J GRUGAN DO PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093847394
- **Authorized official:** DR. MONTY J GRUGAN D.O. (PHYSICAN)
- **Authorized official phone:** (580) 584-3242

## Contact information

- **Practice address:** 117 N BROADWAY ST, BROKEN BOW, OK 74728-3933
- **Practice address phone:** (580) 584-3246
- **Mailing address:** 117 N BROADWAY ST, BROKEN BOW, OK 74728-3933
- **Mailing address phone:** (580) 584-3246

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/12/2007
- **Last updated:** 08/22/2020