Healthcare Provider Details

I. General information

NPI: 1558266841
Provider Name (Legal Business Name): PAXTON MEDICAL MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13501 ICOT BLVD STE 114
CLEARWATER FL
33760-3729
US

IV. Provider business mailing address

13501 ICOT BLVD STE 114
CLEARWATER FL
33760-3729
US

V. Phone/Fax

Practice location:
  • Phone: 727-275-2005
  • Fax:
Mailing address:
  • Phone: 727-754-7880
  • Fax: 727-754-7885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JEFFREY S GROVE
Title or Position: AUTHORIZED OFFICIAL
Credential: D.O.
Phone: 727-275-2005