Provider Demographics
NPI:1033375530
Name:DAVID F GRIDER PA
Entity Type:Organization
Organization Name:DAVID F GRIDER PA
Other - Org Name:BIG PINE MEDICAL & MINOR EMERGENCY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:GRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-872-3321
Mailing Address - Street 1:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:BIG PINE KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33043-0536
Mailing Address - Country:US
Mailing Address - Phone:305-872-3321
Mailing Address - Fax:
Practice Address - Street 1:29960 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:BIG PINE KEY
Practice Address - State:FL
Practice Address - Zip Code:33043-3362
Practice Address - Country:US
Practice Address - Phone:305-872-3321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0004048208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068152100Medicaid
FLE32262Medicare UPIN
FL0886490001Medicare NSC
FL068152100Medicaid