Provider Demographics
NPI:1891793006
Name:GROSBACH, ALAN B (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:B
Last Name:GROSBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SW ARCHER RD
Mailing Address - Street 2:DEPT OF MEDICINE, DIVISION OF HEMATOLOGY/ONCOLOGY
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-3003
Mailing Address - Country:US
Mailing Address - Phone:352-273-7835
Mailing Address - Fax:352-271-4675
Practice Address - Street 1:1601 SW ARCHER RD
Practice Address - Street 2:HEMATOLOGY/ONCOLOGY (111)
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1135
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:352-271-4575
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA04462R207RX0202X
FLME103867207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1942871Medicaid
LA5J223Medicare ID - Type Unspecified
B60369Medicare UPIN
LA1942871Medicaid