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General NPI Number Information
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NPI Number | 1740545466
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Entity Type | Organization
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Legal Business Name | J. WILLIAM GROVES, JR., M.D., L.L.C.
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 1890 W GAUTHIER RD STE 130
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City | LAKE CHARLES
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State | LA
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Zip | 70605-7179
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Country | US
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Telephone | 337-480-5530
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Fax | 337-480-5531
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Provider Business Mailing Address
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Address Line | 1890 W GAUTHIER RD STE 130
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City | LAKE CHARLES
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State | LA
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Zip | 70605-7179
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Country | US
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Telephone | 337-480-5530
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Fax | 337-480-5531
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES WILLIAM GROVES JR.
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Credential | M.D.
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Telephone | 337-480-5530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD.201254
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License Number State | LA
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