Healthcare Provider Details

I. General information

NPI: 1316949944
Provider Name (Legal Business Name): ENRIQUE R GRISONI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10141 BIG BEND RD 103
RIVERVIEW FL
33578-7419
US

IV. Provider business mailing address

PO BOX 743409
ATLANTA GA
30374-3409
US

V. Phone/Fax

Practice location:
  • Phone: 813-397-1274
  • Fax: 813-397-1271
Mailing address:
  • Phone: 727-532-0002
  • Fax: 727-532-1325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberME
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: