Provider Demographics
NPI:1801202312
Name:GROVES, JOHN BENJAMIN (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BENJAMIN
Last Name:GROVES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2900 DOCTORS PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8198
Mailing Address - Country:US
Mailing Address - Phone:541-282-2200
Mailing Address - Fax:541-282-2237
Practice Address - Street 1:2900 DOCTORS PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8198
Practice Address - Country:US
Practice Address - Phone:541-282-2200
Practice Address - Fax:541-282-2237
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA324142207Q00000X
ORDO225068207Q00000X
NC2017-01621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500863725Medicaid
ORDO225068OtherLICENSE
LA324142OtherSTATE LICENSE
LA2555332Medicaid