# GROS VENTRE OB/GYN, LLP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649451907
- **Authorized official:** MAURA LOFARO MD (OWNER)
- **Authorized official phone:** (307) 734-1005

## Contact information

- **Practice address:** 555 E BROADWAY AVE STE 108, JACKSON, WY 83001-8640
- **Practice address phone:** (307) 734-1005
- **Practice address fax:** (307) 734-1065
- **Mailing address:** PO BOX 3306, IDAHO FALLS, ID 83403-3306
- **Mailing address phone:** (307) 734-1005
- **Mailing address fax:** (307) 734-1065

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/15/2007
- **Last updated:** 09/17/2012