Provider Demographics
NPI:1912213935
Name:NELSON, GRODONOFF (DO)
Entity Type:Individual
Prefix:DR
First Name:GRODONOFF
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 SE 17TH ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-9107
Mailing Address - Country:US
Mailing Address - Phone:352-351-0120
Mailing Address - Fax:352-351-0107
Practice Address - Street 1:2300 SE 17TH ST
Practice Address - Street 2:SUITE 402
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-9107
Practice Address - Country:US
Practice Address - Phone:352-351-0120
Practice Address - Fax:352-351-0107
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11869207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine