Healthcare Provider Details

I. General information

NPI: 1811019045
Provider Name (Legal Business Name): DAVID FRANK GRIDER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29980 OVERSEAS HWY
BIG PINE KEY FL
33043-3362
US

IV. Provider business mailing address

PO BOX 430536
BIG PINE KEY FL
33043-0536
US

V. Phone/Fax

Practice location:
  • Phone: 305-872-3321
  • Fax: 305-872-9062
Mailing address:
  • Phone: 305-872-3321
  • Fax: 305-872-9062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS-0004048
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: