Individual
KATHY D. GROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
500 W FORTH ST, ODESSA, TEXAS 79761, TX 78215-1137
(432) 640-1184
Mailing address
15902 LA MADERA RIO, HELOTES, TX 78023-3688
(210) 488-2542
(210) 593-5992
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
L7401
TX
208600000X
Surgery Physician
MD60652282
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0097MB
BLUE CROSS BLUE SHIELD
TX
05
—
160045402
—
TX
05
—
160045404
—
TX
01
—
3776353
AETNA
TX
01
—
6678943
CIGNA
TX
Enumeration date
07/11/2006
Last updated
12/29/2021
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