Provider Demographics
NPI:1790793461
Name:GROSFLAM, JODI M (MD)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:M
Last Name:GROSFLAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13181 PONDEROSA WAY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7821
Mailing Address - Country:US
Mailing Address - Phone:239-415-1100
Mailing Address - Fax:
Practice Address - Street 1:15740 NEW HAMPSHIRE CT
Practice Address - Street 2:SUITE B
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4173
Practice Address - Country:US
Practice Address - Phone:239-415-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71368207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology