Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC27234 | CA |
NPI | 1235313883 |
---|---|
Provider Name | Mr. Shad James Groves |
First Address | Long Beach, CA 90807-4022 |
Second Address | Long Beach, CA 90807-4022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2007 |
Last Update Date | 20/10/2011 |