Healthcare Provider Details

I. General information

NPI: 1366657694
Provider Name (Legal Business Name): DAVID GRIPPE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2733 MOUNT PLEASANT RD
QUINCY FL
32352-6684
US

IV. Provider business mailing address

2733 MOUNT PLEASANT RD
QUINCY FL
32352-6684
US

V. Phone/Fax

Practice location:
  • Phone: 850-856-9703
  • Fax: 850-856-9312
Mailing address:
  • Phone: 850-856-9703
  • Fax: 850-856-9312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberME 59962
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: