Provider Demographics
NPI:1811019045
Name:GRIDER, DAVID FRANK (DO)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:FRANK
Last Name:GRIDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 430536
Mailing Address - Street 2:
Mailing Address - City:BIG PINE KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33043-0536
Mailing Address - Country:US
Mailing Address - Phone:305-872-3321
Mailing Address - Fax:305-872-9062
Practice Address - Street 1:29980 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:BIG PINE KEY
Practice Address - State:FL
Practice Address - Zip Code:33043-3362
Practice Address - Country:US
Practice Address - Phone:305-872-3321
Practice Address - Fax:305-872-9062
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS-0004048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0681521-00Medicaid
FL0886490001Medicare NSC
FL82536Medicare PIN
FLE32262Medicare UPIN