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Organization
GROS VENTRE OB/GYN, LLP
Active
Organization
GROS VENTRE OB/GYN, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAURA LOFARO MD (OWNER)
(307) 734-1005
Entity
Organization
Contact information
Practice address
555 E BROADWAY AVE STE 108, JACKSON, WY 83001-8640
(307) 734-1005
(307) 734-1065
Mailing address
PO BOX 3306, IDAHO FALLS, ID 83403-3306
(307) 734-1005
(307) 734-1065
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
NULL
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Enumeration date
11/15/2007
Last updated
09/17/2012
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