Individual
MR. CALEB W GROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
700 W CENTRAL AVE STE 105, EL DORADO, KS 67042-2187
(316) 322-9813
(316) 322-9806
Mailing address
720 W CENTRAL AVE, EL DORADO, KS 67042-2112
(316) 321-3300
(316) 321-2916
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
T00782
KS
363AS0400X
Surgical Physician Assistant
15-01144
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000427308
BLUE CROSS BLUE SHIELD
KS
05
—
200406070D
—
KS
Enumeration date
10/05/2006
Last updated
09/05/2024
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