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General NPI Number Information
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NPI Number | 1457593865
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Entity Type | Individual
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Provider Name | JESSE GROH M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2009
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Last Update Date | 01/07/2014
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Provider Practice Location Address
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Address Line | 2740 S SAINT PETERS PKWY SUITE A
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City | SAINT PETERS
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State | MO
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Zip | 63303-6355
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Country | US
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Telephone | 636-441-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 515 N VIRGINIA AVE
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City | EUREKA
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State | MO
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Zip | 63025-1115
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Country | US
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Telephone | 636-587-3000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | N1659
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2010007576
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License Number State | MO
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