Provider Demographics
NPI:1851619738
Name:GROVE, JEROD (MD)
Entity Type:Individual
Prefix:
First Name:JEROD
Middle Name:
Last Name:GROVE
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 1:2500 CANTERBURY DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 CANTERBURY DR
Practice Address - Street 2:SUITE 202
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2247
Practice Address - Country:US
Practice Address - Phone:785-623-5945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-07342208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery