1548263759 NPI number — DR. TERRY ALLEN GROVER D.O.

Table of content: DR. TERRY ALLEN GROVER D.O. (NPI 1548263759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548263759 NPI number — DR. TERRY ALLEN GROVER D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROVER
Provider First Name:
TERRY
Provider Middle Name:
ALLEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548263759
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2961 MOSSROCK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78230-5119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-731-4800
Provider Business Mailing Address Fax Number:
210-731-4810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 FALLS COURT
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BOERNE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78006-2986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-249-3800
Provider Business Practice Location Address Fax Number:
830-249-0882
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  L5750 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8L2804 . This is a "MEDICARE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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