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Individual

TED GROSHONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
402 N KEENE ST, STE 101, COLUMBIA, MO 65201-6986
(573) 882-6921
(573) 882-1154
Mailing address
PO BOX 7687, COLUMBIA, MO 65205-7687
(573) 882-2259

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD31289
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
102486
HEALTHLINK
MO
01
140113001
ARKANSAS MEDICAID
AR
05
200528107
MO
01
2086349901
KANSAS MEDICAID
KS
01
3730
BLUE SHIELD/BLUE CHOICE
MO
01
7509311
UNITED HEALTHCARE
MO
Enumeration date
05/22/2006
Last updated
08/16/2011
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