Provider Demographics
NPI:1639584303
Name:GROSSMAN, ROBERT ATHEY (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ATHEY
Last Name:GROSSMAN
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 1:311 9TH ST N STE 308
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5889
Mailing Address - Country:US
Mailing Address - Phone:239-624-4650
Mailing Address - Fax:239-624-4651
Practice Address - Street 1:311 9TH ST N STE 308
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5889
Practice Address - Country:US
Practice Address - Phone:239-624-4650
Practice Address - Fax:239-624-4651
Is Sole Proprietor?:No
Enumeration Date:2014-06-21
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD043980208600000X
FLME127255208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021989100Medicaid
FLOICY2OtherBCBS
FL021989100Medicaid