MEDICARE: DR. ROBERT LEE GRIGSBY III M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	ME34609	FL
2	208D00000X	General Practice Physician	ME34609	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245248475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT LEE GRIGSBY III M.D.

Provider Business Mailing Address
First Line	:	150 GRAFFT LN
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32084-6557
Country	:	US
Telephone Number	:	850-585-5285
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 DOCTORS VILLAGE DR
Second Line	:
City	:	ST JOHNS
State	:	FL
Zip	:	32259-2245
Country	:	US
Telephone Number	:	904-230-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	09/17/2021

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