Provider Demographics
NPI:1154313252
Name:GROVE, JEFFREY SCOTT (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SCOTT
Last Name:GROVE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17222 HOSPITAL BLVD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-8925
Mailing Address - Country:US
Mailing Address - Phone:352-799-7000
Mailing Address - Fax:352-799-7077
Practice Address - Street 1:12020 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-2805
Practice Address - Country:US
Practice Address - Phone:727-588-9572
Practice Address - Fax:727-584-3832
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6098207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370419000Medicaid
FL80599OtherBLUE CROSS
F22129Medicare UPIN
FL370419000Medicaid
FL80599OtherBLUE CROSS