Individual
DR. JED A GROOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
64-1066 MAMALAHOA HWY UNIT B, KAMUELA, HI 96743-7309
(808) 885-6006
(808) 885-0906
Mailing address
64-1066 B MAMALAHOA HWY., KAMUELA, HI 96743-8425
(808) 885-6006
(808) 885-0906
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD4251
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00376101
—
HI
Enumeration date
12/31/2007
Last updated
12/31/2007
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