Basic Information
| Provider Information | |||||||||
| NPI: | 1396716163 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GROLL | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3009 N BALLAS RD | ||||||||
| Address2: | STE. 100B | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631312322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144321111 | ||||||||
| FaxNumber: | 3144326308 | ||||||||
| Practice Location | |||||||||
| Address1: | 3009 N BALLAS RD | ||||||||
| Address2: | STE. 100B | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631312322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144321111 | ||||||||
| FaxNumber: | 3144326308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 01/08/2014 | ||||||||
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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 | R8J11 | MO | N | Other Service Providers | Specialist | 207RC0000X | 036-094904 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.