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General NPI Number Information
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NPI Number | 1861453391
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Entity Type | Individual
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Provider Name | E JAMES GRUVER III MD
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Gender | Male
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Dates
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Enumeration Date | 04/02/2006
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Last Update Date | 12/21/2007
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Provider Practice Location Address
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Address Line | 55 FOGG RD
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City | SOUTH WEYMOUTH
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State | MA
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Zip | 02190-2432
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Country | US
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Telephone | 781-340-8338
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Fax |
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Provider Business Mailing Address
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Address Line | 7 TANGLEWOOD RD
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City | WELLESLEY
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State | MA
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Zip | 02481-2615
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Country | US
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Telephone | 781-235-5579
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Fax | 781-235-5579
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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 | 81065
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License Number State | MA
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