Individual
MR. WILLIAM ANTHONY GROMKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
17055 RUBEN LN, SANDY, OR 97055-9276
(503) 668-8002
(503) 668-5246
Mailing address
17055 RUBEN LN, SANDY, OR 97055-9276
(503) 668-8002
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
14461
WA
207Q00000X
Family Medicine Physician
66750
MN
207Q00000X
Family Medicine Physician
Primary
MD204079
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080168652
PALMETTO GBA
WA
05
—
1112713
—
WA
01
—
147208
WORKERS COMPENSATION
WA
01
—
610278200
U.S. DEPT. OF LABOR
WA
01
—
7280GR
BLUE CROSS BLUE SHIELD
WA
01
—
912107280985030000
TRICARE
WA
Enumeration date
08/12/2006
Last updated
05/11/2021
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