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General NPI Number Information
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NPI Number | 1790735223
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Entity Type | Individual
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Provider Name | RODNEY BLAINE GROVER DO
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3306 RENNER DR
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City | FORTUNA
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State | CA
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Zip | 95540-3120
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Country | US
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Telephone | 707-725-6101
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Fax | 707-725-2978
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Provider Business Mailing Address
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Address Line | PO BOX 1229
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City | WEAVERVILLE
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State | CA
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Zip | 96093-1229
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Country | US
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Telephone | 530-629-2363
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A6001
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License Number State | CA
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