Provider Demographics
NPI:1326039538
Name:GRASS, GERALD WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:WILLIAM
Last Name:GRASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 BAYOU BLVD
Mailing Address - Street 2:SUITE 17B
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1949
Mailing Address - Country:US
Mailing Address - Phone:718-916-7551
Mailing Address - Fax:850-602-9013
Practice Address - Street 1:4300 BAYOU BLVD
Practice Address - Street 2:SUITE 17B
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-1949
Practice Address - Country:US
Practice Address - Phone:718-916-7551
Practice Address - Fax:850-602-9013
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240009207LP2900X
FLME114483207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE15536Medicare UPIN