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General NPI Number Information
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NPI Number | 1861051369
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Entity Type | Organization
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Legal Business Name | JESUS A GROSO MD
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Dates
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Enumeration Date | 06/08/2019
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Last Update Date | 09/22/2019
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Provider Practice Location Address
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Address Line | 1008 N PARROTT AVE
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City | OKEECHOBEE
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State | FL
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Zip | 34972-2110
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Country | US
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Telephone | 863-447-1343
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Fax |
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Provider Business Mailing Address
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Address Line | 2856 NE 54TH TRL
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City | OKEECHOBEE
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State | FL
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Zip | 34972-8609
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Country | US
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Telephone | 863-447-1343
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JESUS A GROSO
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Credential | MD
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Telephone | 863-447-1343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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