Provider Demographics
NPI:1598873036
Name:GROVES, ROBERT HAMILTON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HAMILTON
Last Name:GROVES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 W SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4715
Mailing Address - Country:US
Mailing Address - Phone:480-512-5806
Mailing Address - Fax:480-512-5801
Practice Address - Street 1:2145 W SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4715
Practice Address - Country:US
Practice Address - Phone:480-512-5806
Practice Address - Fax:480-512-5801
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34948207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01314301Medicaid
COCO306410Medicare PIN
E20783Medicare UPIN
COE20783Medicare ID - Type Unspecified
CO01314301Medicaid