Provider Demographics
NPI:1073599130
Name:GROCHMAL, RICHARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:GROCHMAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8614 BAYMEADOWS WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8236
Mailing Address - Country:US
Mailing Address - Phone:904-854-9887
Mailing Address - Fax:904-396-6401
Practice Address - Street 1:8614 BAYMEADOWS WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-8236
Practice Address - Country:US
Practice Address - Phone:904-396-0450
Practice Address - Fax:904-396-6401
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME41245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01028661OtherRAILROAD MEDICARE
FL15769TMedicare PIN
FLP01028661OtherRAILROAD MEDICARE