MEDICARE: CHRISTOPHER ALLEN GROVE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	27210	WV
2	208600000X	Surgery Physician	35-07-3218-G	OH
3	208600000X	Surgery Physician	ME 125954	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306838545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER ALLEN GROVE MD

Provider Business Mailing Address
First Line	:	305 MEMORIAL MEDICAL PKWY STE 207
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-5169
Country	:	US
Telephone Number	:	386-231-3414
Fax Number	:	386-231-3488

Provider Business Practice Location Address
First Line	:	305 MEMORIAL MEDICAL PKWY STE 207
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-5169
Country	:	US
Telephone Number	:	386-231-3414
Fax Number	:	386-231-3488

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	02/18/2021

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Directions to “ CHRISTOPHER ALLEN GROVE MD” Practice Location

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