Healthcare Provider Details

I. General information

NPI: 1831315472
Provider Name (Legal Business Name): ARTHUR J GRIZZLE MD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3148 NORTHSIDE DR
KEY WEST FL
33040-8022
US

IV. Provider business mailing address

3148 NORTHSIDE DR
KEY WEST FL
33040-8022
US

V. Phone/Fax

Practice location:
  • Phone: 305-294-5559
  • Fax: 305-296-8946
Mailing address:
  • Phone: 305-294-5559
  • Fax: 305-296-8946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberME48170
License Number StateFL

VIII. Authorized Official

Name: ARTHUR GRIZZLE
Title or Position: OWNER
Credential: MD
Phone: 305-294-5559