=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962307256
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAXTON MEDICAL MANAGEMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2026
-----------------------------------------------------
Last Update Date | 10/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6150 N US HIGHWAY 41
-----------------------------------------------------
City | APOLLO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33572-1806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-275-2005
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6150 N US HIGHWAY 41
-----------------------------------------------------
City | APOLLO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33572-1806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-641-0007
-----------------------------------------------------
Fax | 813-641-0009
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICAL
-----------------------------------------------------
Name | JEFFREY S GROVE
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 727-275-2005
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------