Provider Demographics
NPI:1710270061
Name:GROW, JOEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:L
Last Name:GROW
Suffix:
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 1:1000 E 23RD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2114
Mailing Address - Country:US
Mailing Address - Phone:605-322-1625
Mailing Address - Fax:605-322-1626
Practice Address - Street 1:1000 E 23RD ST STE 100
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2114
Practice Address - Country:US
Practice Address - Phone:605-322-1625
Practice Address - Fax:605-322-1626
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV270662085R0001X
SD113002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology