JONATHAN L GROSDIDIER (NPI# 1992808398) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992808398 |
| Entity Type | Individual |
| Full Name | JONATHAN L GROSDIDIER |
| Credential | M.D. |
| Practice Address |
111 S 5th St Douglas WY 82633-2434 |
| Practice Telephone | 3073582122 |
| Practice Fax Number | 3073589216 |
| Mailing Telephone | 3073582122 |
| Mailing Fax Number | 3073589216 |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | 7331A | WY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WY | BCBS OF WYOMING | 314089 | 01 |
| Street Address |
111 S 5TH ST |
| City | DOUGLAS |
| State | WY |
| Zip Code | 82633-2434 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689670267 | Phillip O Tigert | Physician Assistant | 111 S 5th St, Douglas, WY 82633-2434 | 2005-06-28 |
| 1972110138 | Melanie Hummert | Physical Therapist | 111 S 5th St, Douglas, WY 82633-2434 | 2020-09-30 |
| 1467070730 | Jordon Jacklin | Physical Therapist | 111 S 5th St, Douglas, WY 82633-2434 | 2020-07-13 |
| 1225662216 | Sara Marie Thronburg | Nurse Practitioner | 111 S 5th St, Douglas, WY 82633-2434 | 2020-02-27 |
| 1902447477 | Amanda Kay Dykes | Nurse Practitioner | 111 S 5th St, Douglas, WY 82633 | 2019-10-04 |
| 1043867872 | Aaron Bernal | Physical Therapist | 111 S 5th St, Douglas, WY 82633-2434 | 2019-08-26 |
| 1033765821 | Hannah Williams | Occupational Therapist | 111 S 5th St, Douglas, WY 82633-2434 | 2019-08-16 |
| 1710457601 | Michael Jeremey Littleton | Emergency Medical Technician, Paramedic | 111 S 5th St, Douglas, WY 82633-2434 | 2018-12-04 |
| 1275054751 | Shelby Hoskinson | Physical Therapist | 111 S 5th St, Douglas, WY 82633-2434 | 2017-07-05 |
| 1811447956 | Melissa Renee Bulkley | Nurse Practitioner | 111 S 5th St, Douglas, WY 82633-2434 | 2016-10-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710304399 | A Keeler Family Dental, LLC | Dentist | 1010 E Richards Street, Douglas, WY 82633 | 2014-03-21 |
| 1578836805 | Dawn Marie Marchak-cundy | Counselor | 1841 Madora Avenue, Douglas, WY 82633 | 2012-02-16 |
| 1982894739 | Tanisha Crystal Dexter | Pharmacist | 1202 East Richards Street, Douglas, WY 82633 | 2007-07-27 |
| 1669521324 | Stephan Paul Ediss | Chiropractor | 1330 E. Richards, Douglas, WY 82633 | 2007-01-10 |
| 1831280221 | Shauna R Kohler | Nurse Anesthetist, Certified Registered | 111 S 5th Street, Douglas, WY 82633 | 2006-09-28 |
| 1255438651 | County of Converse | Public Health or Welfare | 442 Center, Douglas, WY 82633 | 2006-09-20 |
| 1104834134 | Mark W Townsend | Dentist | 820 So 10th, Douglas, WY 82633 | 2006-08-04 |
| 1548206642 | Douglas Care Center, LLC | Skilled Nursing Facility | 1108 Birch, Douglas, WY 82633 | 2006-06-20 |
| 1023061223 | North Platte Physical Therapy Services Inc | Physical Therapist | Crook Co Memorial Serv Dist, Sundance, WY 82633 | 2006-05-18 |
| 1235611468 | Jessica Renee Snyder | Social Worker | 1841 Madora Ave, Douglas, WY 82633 | 2018-09-04 |
| Find all providers in zip 82633 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013277904 | Otis Rodney Vickers | Surgery | 917 Karen Ln, Douglas, GA 31533-3401 | 2012-05-24 |
| 1730126194 | Concordio F Ursal | Surgery | 2106 Ocilla Rd, Douglas, GA 31533 | 2006-06-02 |
| 1205829207 | William Charles Miller Jr. | Surgery | 203 Shirley Ave, Douglas, GA 31533-2327 | 2005-08-24 |
| 1336132646 | Romulo P Navarro | Surgery | 100 Doctors Dr Ste C, Douglas, GA 31533-2211 | 2005-08-23 |
| 1023418928 | Irwin County Hospital | Surgery | 2016 Ocilla Rd, Douglas, GA 31533-2230 | 2014-08-27 |
| 1710205927 | Douglas Medical & Surgical Group, PC | Surgery | 203 Shirley Ave, Douglas, GA 31533-2327 | 2010-05-12 |
| 1194974816 | Chester Theo Royals Jr. | Surgery | 100 Doctors Dr Ste C, Douglas, GA 31533-2211 | 2008-09-18 |
| 1598827974 | Medical South PC | Surgery | 1309 Ocilla Rd, Suite A, Douglas, GA 31533-2209 | 2006-12-14 |
| 1932280682 | Thomas W Wehmann | Surgery | 100 Doctors Dr Ste C, Douglas, GA 31533-2211 | 2006-10-18 |
| 1457461774 | William Leslie White | Surgery | 111 S 5th St, Douglas, WY 82633-2434 | 2006-08-30 |
| Find all providers in DOUGLAS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.