MEDICARE: JEFFREY DOUGLAS GROW M.D.

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	207Q00000X	Family Medicine Physician	0101038571	VA

General Provider Information

NPI Number	:	1871572669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY DOUGLAS GROW M.D.

Provider Business Mailing Address
First Line	:	1585 3RD ST
Second Line	:
City	:	FORT POLK
State	:	LA
Zip	:	71459-5102
Country	:	US
Telephone Number	:	207-530-6514
Fax Number	:

Provider Business Practice Location Address
First Line	:	1585 3RD ST
Second Line	:
City	:	FORT POLK
State	:	LA
Zip	:	71459-5102
Country	:	US
Telephone Number	:	207-530-6514
Fax Number	:

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	08/02/2022

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