Provider Demographics
NPI:1417170556
Name:GROVES, ROBERT GENE
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GENE
Last Name:GROVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 405
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73522-0405
Mailing Address - Country:US
Mailing Address - Phone:580-482-8808
Mailing Address - Fax:
Practice Address - Street 1:608 MARKET RD
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-3353
Practice Address - Country:US
Practice Address - Phone:580-482-8808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor