Individual
DR. MACK JAY GROVES IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
323 S TYLER ST, COVINGTON, LA 70433-3037
(985) 867-9605
(985) 867-9001
Mailing address
323 S STREET, COVINGTON, LA 70433-2352
(985) 867-9605
(985) 867-9001
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
PD190R
LA
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
DPM.190R
LA
213ES0131X
Foot Surgery Podiatrist
PD190R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1265460877
BLUECROSS
—
Enumeration date
06/30/2006
Last updated
06/30/2025
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