Provider Demographics
NPI:1740283050
Name:GROUX, WAYNE E (MD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:E
Last Name:GROUX
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 1:40 MEDICAL PARK
Mailing Address - Street 2:STE 504
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6392
Mailing Address - Country:US
Mailing Address - Phone:304-242-0588
Mailing Address - Fax:304-242-7267
Practice Address - Street 1:40 MEDICAL PARK
Practice Address - Street 2:STE 504
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6392
Practice Address - Country:US
Practice Address - Phone:304-242-0588
Practice Address - Fax:304-242-7267
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV14070207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001491Medicaid
WVE29702Medicare UPIN
WVGRO640474Medicare ID - Type Unspecified