Provider Demographics
NPI:1609860600
Name:GROVER, SCOTT W (DO)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:W
Last Name:GROVER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 N 400 E STE E
Mailing Address - Street 2:
Mailing Address - City:NORTH LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-1767
Mailing Address - Country:US
Mailing Address - Phone:435-752-7122
Mailing Address - Fax:435-755-9579
Practice Address - Street 1:2380 N 400 E STE E
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1767
Practice Address - Country:US
Practice Address - Phone:435-752-7122
Practice Address - Fax:435-755-9579
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-220208600000X
UT5215595-1204208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTG48940Medicare UPIN
UT005716801Medicare ID - Type Unspecified