Provider Demographics
NPI:1699838979
Name:GROSSMAN, JOEL SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:SCOTT
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:ATTN CREDENTIALING DEPT
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:1100 GOODLETTE RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5451
Practice Address - Country:US
Practice Address - Phone:239-434-0656
Practice Address - Fax:239-261-0060
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2022-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME87392207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78612OtherBCBS
FLP00018034OtherRR MEDICARE
FL266945500Medicaid
FLP00018034OtherRR MEDICARE
G30756Medicare UPIN