Provider Demographics
NPI:1629196399
Name:GROVES, JEFFREY W (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:GROVES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:96 E KIMBALLS LN
Practice Address - Street 2:SUITE 307
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5020
Practice Address - Country:US
Practice Address - Phone:801-260-3286
Practice Address - Fax:801-260-3285
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT575511312052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology