Individual
JASON CHARLES GROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5115 BERNARD DR, SUITE 105, ROANOKE, VA 24018-4357
(540) 728-1570
Mailing address
5115 BERNARD DR, SUITE 105, ROANOKE, VA 24018-4357
(540) 728-1570
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
0102202832
VA
390200000X
Student in an Organized Health Care Education/Training Program
0116019726
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982801288
—
VA
Enumeration date
06/29/2007
Last updated
02/27/2024
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