Individual
TYRREL C GROHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4920 NE STALLINGS DR, NACOGDOCHES, TX 75965
(936) 569-9481
Mailing address
PO BOX 2887, PORT ARTHUR, TX 77643-2887
(800) 945-2455
(903) 453-2541
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
H5559
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
132173907
—
TX
Enumeration date
04/18/2006
Last updated
05/09/2008
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