Provider Demographics
NPI:1124084694
Name:SCHLEIFER, GROVER FERDINAND III (MD)
Entity type:Individual
Prefix:DR
First Name:GROVER
Middle Name:FERDINAND
Last Name:SCHLEIFER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1720 E. REELFOOT AVE.
Mailing Address - Street 2:STE 103
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-6048
Mailing Address - Country:US
Mailing Address - Phone:731-886-1240
Mailing Address - Fax:731-886-1234
Practice Address - Street 1:1720 E. REELFOOT AVE.
Practice Address - Street 2:STE 103
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-6048
Practice Address - Country:US
Practice Address - Phone:731-886-1240
Practice Address - Fax:731-886-1234
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3148109Medicaid
TN3148109Medicaid
B59209Medicare UPIN
TN1124084694Medicare PIN