Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 1239 | ME |
Y | 207V00000X | Obstetrician & Gynecologist | 2018030728 | MO |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 2018030728 | MO |
NPI | 1649299546 |
---|---|
Provider Name | Dr. Robert A Grover |
First Address | Veazie, ME 04401-7055 |
Second Address | Osage Beach, MO 65065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 27/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
011020 | ANTHEM BLUE SHIELD (01) | ME |
12702099 | (05) | ME |
F02520 | (02) | ME |