MEDICARE: DR. JOHN ANTHONY GRISNIK M.D.

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	207Q00000X	Family Medicine Physician	ME43199	FL

General Provider Information

NPI Number	:	1356301097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ANTHONY GRISNIK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 44008
Second Line	:	UFJP PROVIDER ENROLLMENT
City	:	JACKSONVILLE
State	:	FL
Zip	:	32231-4008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1255 LILA ST
Second Line	:	UFJP LEM TURNER FAMILY PRACTICE CENTER
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-3550
Country	:	US
Telephone Number	:	904-244-5700
Fax Number	:	904-244-5791

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

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	04/02/2008

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