Healthcare Provider Details

I. General information

NPI: 1467689232
Provider Name (Legal Business Name): JOSEPH R GRAJO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD # 100374
GAINESVILLE FL
32610-3571
US

IV. Provider business mailing address

1600 SW ARCHER RD # 100374
GAINESVILLE FL
32610-3003
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0291
  • Fax:
Mailing address:
  • Phone: 352-265-0279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME107668
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: