Basic Information
| Provider Information | |||||||||
| NPI: | 1699965442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRONDIN | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 915 6TH AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534037277 | ||||||||
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| Practice Location | |||||||||
| Address1: | 915 6TH AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534037277 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2007 | ||||||||
| LastUpdateDate: | 03/28/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | N | Other Service Providers | Specialist | 207T00000X | 35092472 | OH | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | MD60440903 | WA | Y | Allopathic & Osteopathic Physicians | Neurological Surgery | 208000000X | MD60440903 | WA | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.