Provider Demographics
NPI:1629223003
Name:GROVER, PAUL WILLIS
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:WILLIS
Last Name:GROVER
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 1:40752 W ROBBINS DR
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85238-6592
Mailing Address - Country:US
Mailing Address - Phone:602-418-6417
Mailing Address - Fax:520-423-9291
Practice Address - Street 1:40752 W ROBBINS DR
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85238-6592
Practice Address - Country:US
Practice Address - Phone:602-418-6417
Practice Address - Fax:520-423-9291
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health