# BETHEL MEDICAL GROUP PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bethel Medical Group PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861607558
- **Authorized official:** DR. DOUGLAS R GROGAN M.D. (CEO)
- **Authorized official phone:** (508) 588-1200

## Contact information

- **Practice address:** 111 TORREY ST, BROCKTON, MA 02301-4800
- **Practice address phone:** (508) 588-1200
- **Practice address fax:** (508) 941-0497
- **Mailing address:** PO BOX 848889, BOSTON, MA 02284-8889
- **Mailing address phone:** (508) 588-1200
- **Mailing address fax:** (508) 941-0497

## Taxonomy

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

## Other

- **Enumeration date:** 05/14/2007
- **Last updated:** 04/04/2016