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NPI Code Detail

MEDICARE: DR. JEROME JULIAN GROVE MD

MEDICARE: DR. JEROME JULIAN 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
1174400000XSpecialistL15479RLA
2208VP0014XInterventional Pain Medicine Physician37166AZ

General Provider Information

NPI Number : 1932153236
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEROME JULIAN GROVE MD
Provider Business Mailing Address
First Line : 20950 N TATUM BLVD STE 100
Second Line :
City : PHOENIX
State : AZ
Zip : 85050-4204
Country : US
Telephone Number : 480-222-7246
Fax Number : 480-222-7271
Provider Business Practice Location Address
First Line : 20950 N TATUM BLVD STE 100
Second Line :
City : PHOENIX
State : AZ
Zip : 85050-4204
Country : US
Telephone Number : 480-222-7246
Fax Number : 480-222-7271
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2006
Last Update Date : 02/19/2020

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