Basic Information
| Provider Information | |||||||||
| NPI: | 1821043704 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GROW | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | FOSTER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 605 N CLEVELAND MASSILLON RD | ||||||||
| Address2: | STE. B | ||||||||
| City: | FAIRLAWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443332241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306663333 | ||||||||
| FaxNumber: | 3306686532 | ||||||||
| Practice Location | |||||||||
| Address1: | 605 N CLEVELAND MASSILLON RD | ||||||||
| Address2: | STE. B | ||||||||
| City: | FAIRLAWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443332241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306663333 | ||||||||
| FaxNumber: | 3306686532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 11/02/2011 | ||||||||
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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 | 207QG0300X | 35.030368 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0375325 | 01 | MEDICARE ID | OTHER | 0274162 | 05 | OH | MEDICAID | 0375326 | 01 | MEDICARE ID | OTHER |