Basic Information
Provider Information
NPI: 1548822570
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GROFF
FirstName: VERONICA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: YOUNG
OtherFirstName: VERONICA
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 660 S EUCLID AVE
Address2: EMERGENCY MEDICINE
City: SAINT LOUIS
State: MO
PostalCode: 631101010
CountryCode: US
TelephoneNumber: 3143625000
FaxNumber:  
Practice Location
Address1: 1 BARNES JEW HOSP PLZ
Address2:  
City: SAINT LOUIS
State: MO
PostalCode: 631101003
CountryCode: US
TelephoneNumber: 3143625000
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/29/2019
LastUpdateDate: 06/29/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X2019023450MOY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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