Provider Demographics
NPI:1447410634
Name:JULIE GROVER MD PC
Entity type:Organization
Organization Name:JULIE GROVER MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-357-7377
Mailing Address - Street 1:1055 N 300 W
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3381
Mailing Address - Country:US
Mailing Address - Phone:801-357-7377
Mailing Address - Fax:801-357-7378
Practice Address - Street 1:1055 N 300 W
Practice Address - Street 2:SUITE 108
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3381
Practice Address - Country:US
Practice Address - Phone:801-357-7377
Practice Address - Fax:801-357-7378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT85-172886207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057186Medicare PIN