MEDICARE: DR. NORMAN RALPH GROVER 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	207W00000X	Ophthalmology Physician	ME0024168	FL

General Provider Information

NPI Number	:	1770673915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NORMAN RALPH GROVER MD

Provider Business Mailing Address
First Line	:	4420 SHERIDAN ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3552
Country	:	US
Telephone Number	:	954-962-0222
Fax Number	:	954-987-2444

Provider Business Practice Location Address
First Line	:	4420 SHERIDAN ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3552
Country	:	US
Telephone Number	:	954-962-0222
Fax Number	:	954-987-2444

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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