MEDICARE: RICHARD E. GROUT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD070480L	PA
2	2080N0001X	Neonatal-Perinatal Medicine Physician	MD070480L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164427589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD E. GROUT MD

Provider Business Mailing Address
First Line	:	14205 PINE VALLEY RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32826-5276
Country	:	US
Telephone Number	:	814-771-9682
Fax Number	:

Provider Business Practice Location Address
First Line	:	14205 PINE VALLEY RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32826-5276
Country	:	US
Telephone Number	:	814-771-9682
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	03/16/2015

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