Individual
STANLEY E. GROGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
635 W 11TH ST, TULSA, OK 74127-9014
(918) 382-3100
Mailing address
2345 SOUTHWEST BLVD, TULSA, OK 74107-2705
(918) 582-1980
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
1598
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100045720C
—
OK
Enumeration date
03/17/2006
Last updated
06/29/2008
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