Individual provider · Type 1 NPI

Madison Rae Groberg

Medical Physician Assistant · Logan, UT

NPI number 1043837404 Active

Practice location

115 Golf Course Rd Ste E
Logan, UT 84321-5934

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant 363A00000XNone listed
Medical Physician Assistant Primary 363AM0700XPA-2019 (ID)

Medical Physician Assistant: Definition to come...

14 other providers at this address

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About NPI 1043837404

Madison Rae Groberg's National Provider Identifier is 1043837404, issued on Jul 1, 2020. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Logan, UT. The record was last updated on Apr 29, 2026.