Healthcare Provider Details

I. General information

NPI: 1609860600
Provider Name (Legal Business Name): SCOTT W GROVER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 N 400 E STE E
NORTH LOGAN UT
84341-1767
US

IV. Provider business mailing address

2380 N 400 E STE E
NORTH LOGAN UT
84341-1767
US

V. Phone/Fax

Practice location:
  • Phone: 435-752-7122
  • Fax: 435-755-9579
Mailing address:
  • Phone: 435-752-7122
  • Fax: 435-755-9579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberO-220
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5215595-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: