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General NPI Number Information
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NPI Number | 1033381280
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Entity Type | Organization
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Legal Business Name | BRUCE M GROSSMAN M D P A
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 06/07/2008
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Provider Practice Location Address
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Address Line | 3370 BURNS RD 105
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4327
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Country | US
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Telephone | 561-691-9660
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Fax | 561-691-9633
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Provider Business Mailing Address
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Address Line | 3370 BURNS RD 105
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4327
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Country | US
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Telephone | 561-691-9660
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Fax | 561-691-9633
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LOIS T CARLISLE
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Credential |
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Telephone | 561-691-9660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 0053017
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License Number State | FL
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