Individual
DR. JERZY GRZEBIELUCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4 2ND ST SE, FORT WALTON BEACH, FL 32548-5502
(850) 864-2008
(850) 864-5008
Mailing address
4 2ND ST SE, FORT WALTON BEACH, FL 32548-5502
(850) 864-2008
(850) 864-5008
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME82784
FL
2084P0804X
Child & Adolescent Psychiatry Physician
ME82784
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13115
BCBS OF FLORIDA
FL
01
—
53114
SPECIALITY LICENSE
FL
01
—
ME 82784
FLORIDA LICENSE
FL
Enumeration date
08/24/2006
Last updated
03/07/2023
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