Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 2020013859 | MO |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 2020013859 | MO |
NPI | 1689054553 |
---|---|
Provider Name | Dr. Caleb W Grote |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2015 |
Last Update Date | 02/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200048943 | (05) | MO |
ENROLLED | (05) | IL |