Individual
JEREMY R GROVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2918 W 10TH ST, GREELEY, CO 80634-5457
(970) 584-2100
(970) 584-2101
Mailing address
2918 W 10TH ST, GREELEY, CO 80634-5457
(970) 584-2100
(970) 584-2101
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1625
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1625
STATE LISENCE NUMBER
CO
01
—
C462078
MEDICARE GROUP
CO
Enumeration date
09/22/2006
Last updated
10/30/2012
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