Provider Demographics
NPI:1255522488
Name:GRUNBAUM, ADAM JACOB (DO, FACOI, FACR)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:JACOB
Last Name:GRUNBAUM
Suffix:
Gender:M
Credentials:DO, FACOI, FACR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9332 STATE ROAD 54 STE 301
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1810
Mailing Address - Country:US
Mailing Address - Phone:727-940-9391
Mailing Address - Fax:727-937-4003
Practice Address - Street 1:9332 STATE ROAD 54 STE 301
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1810
Practice Address - Country:US
Practice Address - Phone:727-940-9391
Practice Address - Fax:727-937-4003
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9755207RR0500X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology