Basic Information
| Provider Information | |||||||||
| NPI: | 1710270061 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GROW | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 E 23RD ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571052114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053221625 | ||||||||
| FaxNumber: | 6053221626 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 E 23RD ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571052114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053221625 | ||||||||
| FaxNumber: | 6053221626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2011 | ||||||||
| LastUpdateDate: | 01/30/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 27066 | WV | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 11300 | SD | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.