Individual
CHARLES A GROVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8900 SE 165TH MULBERRY LN, THE VILLAGES, FL 32162-5884
(352) 674-5000
Mailing address
8900 SE 165TH MULBERRY LN, THE VILLAGES, FL 32162-5884
(352) 674-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01039464
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000295923
ANTHEM
IN
05
—
200020550
—
IN
01
—
352146688
TAX ID
IN
Enumeration date
10/12/2006
Last updated
07/09/2014
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