Basic Information
| Provider Information | |||||||||
| NPI: | 1780648667 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRUMBT | ||||||||
| FirstName: | WALTER | ||||||||
| MiddleName: | HERBERT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PA-C,PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 129 BROOKWOOD CT | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660431557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137275263 | ||||||||
| FaxNumber: | 9137586986 | ||||||||
| Practice Location | |||||||||
| Address1: | 129 BROOKWOOD CT | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660431557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137275263 | ||||||||
| FaxNumber: | 9137586986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 2955 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.