Provider Demographics
NPI:1821179888
Name:GROBLEWSKI, DANIEL BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BERNARD
Last Name:GROBLEWSKI
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 1:3627 UNIVERSITY BLVD S
Mailing Address - Street 2:STE 255
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4230
Mailing Address - Country:US
Mailing Address - Phone:904-396-4666
Mailing Address - Fax:904-396-4777
Practice Address - Street 1:3627 UNIVERSITY BLVD S
Practice Address - Street 2:STE 255
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4230
Practice Address - Country:US
Practice Address - Phone:904-396-4666
Practice Address - Fax:904-396-4777
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME826742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060442Medicare ID - Type Unspecified
G33765Medicare UPIN