Provider Demographics
NPI:1861694903
Name:GROW, PAMELA K (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:K
Last Name:GROW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N PINE ST
Mailing Address - Street 2:STUDENT HEALTH SERVICES
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2831
Mailing Address - Country:US
Mailing Address - Phone:573-341-4284
Mailing Address - Fax:573-341-6967
Practice Address - Street 1:1200 N PINE ST
Practice Address - Street 2:STUDENT HEALTH SERVICES
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2831
Practice Address - Country:US
Practice Address - Phone:573-341-4284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD R8J04208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics