Organization
GORDON GRENN D.O., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GORDON L. GRENN D.O. (DOCTOR)
(561) 964-4077
Entity
Organization
Contact information
Practice address
4002 RAULERSON DR, LAKE WORTH, FL 33463-8927
(561) 964-4077
(561) 964-9296
Mailing address
4002 RAULERSON DR, LAKE WORTH, FL 33463-8927
(561) 964-4077
(561) 964-9296
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS0003345
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
265885200
—
FL
Enumeration date
11/02/2010
Last updated
05/17/2011
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