Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 35047195 | OH |
NPI | 1003801721 |
---|---|
Provider Name | Dr. Paul F Grote |
First Address | West Chester, OH 45069 |
Second Address | West Chester, OH 45069 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 16/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000010817 | ANTHEM (01) | OH |
0494291 | (05) | OH |
31103367900 | WORKERS COMP (01) | OH |
A15189 | (02) |