Provider Demographics
NPI:1356326185
Name:GRASMAN, BRAD MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:MATTHEW
Last Name:GRASMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BRAD
Other - Middle Name:MATTHEW
Other - Last Name:GRASMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1600 36TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4875
Mailing Address - Country:US
Mailing Address - Phone:772-569-6112
Mailing Address - Fax:772-569-5058
Practice Address - Street 1:1600 36TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4875
Practice Address - Country:US
Practice Address - Phone:772-569-6112
Practice Address - Fax:772-569-5058
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0089867207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI15202Medicare UPIN
FL39117Medicare PIN