Individual
EDWIN L. GROGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1532 LONE OAK RD, SUITE 235, PADUCAH, KY 42003-7913
(270) 442-9463
(270) 442-2241
Mailing address
PO BOX 636961, CINCINNATI, OH 45263-0001
(513) 981-5098
(513) 981-5015
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036093089
IL
208600000X
Surgery Physician
Primary
20054
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04705710211
—
IL
05
—
64200546
—
KY
01
—
P00976650
RAIL ROAD MEDICARE
KY
Enumeration date
10/03/2005
Last updated
03/06/2013
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