Provider Demographics
NPI:1235127937
Name:GRILLO, DENIS WALTER (DO)
Entity Type:Individual
Prefix:DR
First Name:DENIS
Middle Name:WALTER
Last Name:GRILLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:790 SE 5TH TER
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4852
Mailing Address - Country:US
Mailing Address - Phone:352-795-0011
Mailing Address - Fax:352-795-9481
Practice Address - Street 1:790 SE 5TH TER
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4852
Practice Address - Country:US
Practice Address - Phone:352-795-0011
Practice Address - Fax:352-795-9481
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5716207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1409549OtherUMW
FL80221OtherBCBS OF FLORIDA
FL200691OtherAVMED
FLP00062969OtherMEDICARE RAILROAD
FL200691OtherAVMED
FLB53251Medicare UPIN
FL80221XMedicare PIN