MEDICARE: LUKE JAMES GROME

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208200000X	Plastic Surgery Physician	U5416	TX

General Provider Information

NPI Number	:	1730610064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKE JAMES GROME

Provider Business Mailing Address
First Line	:	45 HICKORY DR
Second Line	:
City	:	BARBOURSVILLE
State	:	WV
Zip	:	25504-2243
Country	:	US
Telephone Number	:	304-544-6138
Fax Number	:

Provider Business Practice Location Address
First Line	:	6701 FANNIN ST STE 610
Second Line	:	DIVISION OF PLASTIC SURGERY
City	:	HOUSTON
State	:	TX
Zip	:	77030-2609
Country	:	US
Telephone Number	:	832-822-3145
Fax Number	:

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

Provider Enumeration Date	:	03/27/2017
Last Update Date	:	05/14/2024

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