Individual
CHARLES GROOTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
323 E HAWKINS PKWY STE A, LONGVIEW, TX 75605-7905
(903) 758-2746
(903) 758-7127
Mailing address
323 E HAWKINS PKWY STE A, LONGVIEW, TX 75605-7905
(903) 758-2746
(903) 758-7127
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
060461
GA
207X00000X
Orthopaedic Surgery Physician
Q4967
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
350010001
—
TX
01
—
Q4967
TEXAS MEDICAL BOARD
TX
Enumeration date
04/19/2008
Last updated
12/19/2023
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