Provider Demographics
NPI:1912030214
Name:GROSHELL, HOWARD J (DPM)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:J
Last Name:GROSHELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3405
Mailing Address - Country:US
Mailing Address - Phone:904-389-0346
Mailing Address - Fax:904-246-5449
Practice Address - Street 1:1205 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3405
Practice Address - Country:US
Practice Address - Phone:904-389-0346
Practice Address - Fax:904-246-5449
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2021213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
480010579OtherRR MC
FL340438200Medicaid
FL65115OtherBCBS
U09936Medicare UPIN
FL65115ZMedicare ID - Type Unspecified