Provider Demographics
NPI:1730610064
Name:GROME, LUKE JAMES
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:JAMES
Last Name:GROME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-2243
Mailing Address - Country:US
Mailing Address - Phone:304-544-6138
Mailing Address - Fax:
Practice Address - Street 1:6701 FANNIN ST STE 610
Practice Address - Street 2:DIVISION OF PLASTIC SURGERY
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2609
Practice Address - Country:US
Practice Address - Phone:832-822-3145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXU5416208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program