Active NPI
Gary L. Grogan, PHD
- Psychologist
- Lewiston, ID
National Provider Identifier
1508264995
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY-203016
- Practice address
- 633 Main Street
B#1
Lewiston, ID 83501 - Phone
- (208) 724-0489
- NPI assigned
- Dec 17, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY-203016 | ID | Primary |
Addresses
Primary practice location
633 Main Street
B#1
Lewiston, ID 83501
Mailing address
633 Main Street B#1
Lewiston, ID 83501
Phone (208) 724-0489
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY-203016 | ID | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1418774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1508264995",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "633 MAIN STREET B#1",
"city": "LEWISTON",
"state": "ID",
"postal_code": "83501",
"telephone_number": "208-724-0489"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "633 MAIN STREET",
"address_2": "B#1",
"city": "LEWISTON",
"state": "ID",
"postal_code": "83501",
"telephone_number": "208-724-0489"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROGAN",
"first_name": "GARY",
"middle_name": "L.",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-12-17",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "ID",
"license": "PSY-203016",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lewiston, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.