Healthcare Provider Details

I. General information

NPI: 1982676888
Provider Name (Legal Business Name): JOHN PAUL GROSSMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10195 W TWAIN AVE SUITE B
LAS VEGAS NV
89147-6726
US

IV. Provider business mailing address

PO BOX 5519
HUDSON FL
34674-5519
US

V. Phone/Fax

Practice location:
  • Phone: 727-868-9563
  • Fax: 727-869-6909
Mailing address:
  • Phone: 727-868-9563
  • Fax: 727-869-6909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number16379
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: