Basic Information
Provider Information
NPI: 1437121324
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GROVER
FirstName: SANDEEP
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 44008
Address2: UFJP OPHTHALMOLOGY DEPT.
City: JACKSONVILLE
State: FL
PostalCode: 322314008
CountryCode: US
TelephoneNumber: 9042443890
FaxNumber: 9042443425
Practice Location
Address1: 580 W 8TH ST
Address2: UFJP OPHTHALMOLOGY DEPT.
City: JACKSONVILLE
State: FL
PostalCode: 322096533
CountryCode: US
TelephoneNumber: 9042443890
FaxNumber: 9042443425
Other Information
ProviderEnumerationDate: 02/03/2006
LastUpdateDate: 12/02/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000XME93906FLY Allopathic & Osteopathic PhysiciansOphthalmology 

No ID Information.


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