Individual
RANDALL PAUL GROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1101 JOHNSON AVE, MYRTLE BEACH, SC 29577-1893
(843) 477-0177
Mailing address
1101 JOHNSON AVE, MYRTLE BEACH, SC 29577-1893
(843) 477-0177
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA001516L
PA
Other
Enumeration date
08/19/2005
Last updated
10/19/2017
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