Grenn, Gordon L
Grenn, Gordon L is an sole proprietor health care provider with primary practice located at 4002 Raulerson Dr , Lake Worth FL 33463-8927. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Grenn, Gordon L can be contacted via phone (561) 964-4077.Contact Information
Primary practice address
4002 Raulerson Dr
Lake Worth FL 33463-8927
Phone: (561) 964-4077
Fax: (561) 964-9296
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | OS0003345 | Florida |
Profile Details
| NPI number | 1871603670 |
|---|---|
| LBN Legal business name | Grenn, Gordon L |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 30th, 2006 |
| Last updated | Jun 10th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1871603670 | NPPES |
| Florida | MEDICAID | 265885200 |
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