Individual
JONATHAN L GROSDIDIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 S 5TH ST, DOUGLAS, WY 82633-2434
(307) 358-2122
(307) 358-9216
Mailing address
111 S 5TH ST, DOUGLAS, WY 82633-2434
(307) 358-2122
(307) 358-9216
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
7331A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
314089
BCBS OF WYOMING
WY
Enumeration date
09/07/2006
Last updated
07/08/2007
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