Healthcare Provider Details

I. General information

NPI: 1891793006
Provider Name (Legal Business Name): ALAN B GROSBACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD HEMATOLOGY/ONCOLOGY (111)
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

1600 SW ARCHER RD DEPT OF MEDICINE, DIVISION OF HEMATOLOGY/ONCOLOGY
GAINESVILLE FL
32610-3003
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1611
  • Fax: 352-271-4575
Mailing address:
  • Phone: 352-273-7835
  • Fax: 352-271-4675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number04462R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME103867
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: