Provider Demographics
NPI:1639159288
Name:GROSSMAN, JEFFREY M (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:920 37TH PL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6573
Mailing Address - Country:US
Mailing Address - Phone:772-299-4046
Mailing Address - Fax:772-299-0419
Practice Address - Street 1:960 37TH PL
Practice Address - Street 2:SUITE 104
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6586
Practice Address - Country:US
Practice Address - Phone:772-299-4046
Practice Address - Fax:772-299-0419
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2011-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME64361207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110225109OtherRAILROAD MEDICARE
FL4629057OtherCIGNA
FL23048OtherBC/BS
FL110225109OtherRAILROAD MEDICARE
FL4629057OtherCIGNA