Healthcare Provider Details

I. General information

NPI: 1205465705
Provider Name (Legal Business Name): MEREDITH ELAINE GROVER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 NE BROADWAY
PORTLAND OR
97213-1422
US

IV. Provider business mailing address

2121 NE 139TH ST STE 400
VANCOUVER WA
98686-2301
US

V. Phone/Fax

Practice location:
  • Phone: 503-249-8787
  • Fax:
Mailing address:
  • Phone: 360-254-7750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.MD.61422980
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP10070694
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD224450
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: