Provider Demographics
NPI:1275610172
Name:WAYNE E. GROUX, M.D., PLLC
Entity Type:Organization
Organization Name:WAYNE E. GROUX, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GROUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-242-0588
Mailing Address - Street 1:40 MEDICAL PARK
Mailing Address - Street 2:SUITE 504
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6392
Mailing Address - Country:US
Mailing Address - Phone:304-242-0588
Mailing Address - Fax:304-242-7267
Practice Address - Street 1:40 MEDICAL PARK
Practice Address - Street 2:SUITE 504
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6392
Practice Address - Country:US
Practice Address - Phone:304-242-0588
Practice Address - Fax:304-242-7267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14070207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVE29702Medicare PIN