Provider Demographics
NPI:1134260110
Name:GROGAN, THOMAS JAMES JR (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JAMES
Last Name:GROGAN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:11710 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1503
Mailing Address - Country:US
Mailing Address - Phone:310-828-5441
Mailing Address - Fax:310-453-2245
Practice Address - Street 1:11710 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1503
Practice Address - Country:US
Practice Address - Phone:310-828-5441
Practice Address - Fax:310-453-2245
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG046706207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A92669Medicare UPIN