Provider Demographics
NPI: | 1639141104 |
---|---|
Name: | DEGROFF, CURT G (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | CURT |
Middle Name: | G |
Last Name: | DEGROFF |
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: | PO BOX 918025 |
Mailing Address - Street 2: | |
Mailing Address - City: | ORLANDO |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32891-8025 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 352-273-7770 |
Mailing Address - Fax: | 352-392-0547 |
Practice Address - Street 1: | 1600 SW ARCHER RD |
Practice Address - Street 2: | |
Practice Address - City: | GAINESVILLE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32610-3003 |
Practice Address - Country: | US |
Practice Address - Phone: | 352-273-7770 |
Practice Address - Fax: | 352-392-0547 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-02-07 |
Last Update Date: | 2011-11-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MD426300 | 174400000X |
FL | ME102470 | 2080P0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2080P0202X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
No | 174400000X | Other Service Providers | Specialist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 101316176 | Medicaid | |
PA | F11355 | Medicare UPIN | |
PA | 093226 | Medicare ID - Type Unspecified | |
PA | 101316176 | Medicaid |