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General NPI Number Information
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NPI Number | 1164955027
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Entity Type | Organization
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Legal Business Name | GULF COAST RHEUMATOLOGY, PLLC
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 01/23/2019
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Provider Practice Location Address
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Address Line | 9332 STATE ROAD 54 STE 301
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City | TRINITY
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State | FL
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Zip | 34655-1810
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Country | US
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Telephone | 727-940-9391
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Fax | 727-937-4003
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Provider Business Mailing Address
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Address Line | 850 E LIME ST # 1939
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-4702
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Country | US
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Telephone | 727-940-9391
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Fax | 727-937-4003
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | ADAM JACOB GRUNBAUM
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Credential | DO, FACOI, FACR
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Telephone | 727-940-9391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | OS9755
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License Number State | FL
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