Provider Demographics
NPI:1144315698
Name:GROESBECK, PHILIP D (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:D
Last Name:GROESBECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 NORTH CENTER ST #800
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:1034 NORTH 500 WEST
Practice Address - Street 2:UTAH VALLEY REGIONAL MEDICAL CENTER
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD223040207L00000X
UT92-187271-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100501287Medicaid
WY116130000Medicaid
UT59049OtherPEHP
UT2090168OtherUNITED HEALTHCARE
UTQM0000075886OtherALTIUS
UT18727112000001OtherBCBS
UT42847OtherHEALTHY U
AZ821985Medicaid
UT231849OtherDESERET MUTUAL
UT107007348101OtherIHC
UT1502954OtherUMWA
ID805948300Medicaid
UT870545614GROOtherEDUCATORS MUTUAL
UTPRA01324OtherMOLINA
WY116130000Medicaid
UTG06473Medicare UPIN
UT050077900Medicare ID - Type UnspecifiedRAILROAD MEDICARE