Organization
DESTIN VEIN CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD J GRISOLI MD (OWNER)
(850) 654-5222
Entity
Organization
Contact information
Practice address
4485 FURLING LN, DESTIN, FL 32541-5331
(850) 654-5222
(850) 637-8020
Mailing address
4485 FURLING LN, DESTIN, FL 32541-5331
(850) 654-5222
(850) 637-8020
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME92186
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME92186
STATE LICENSE
FL
Enumeration date
11/15/2007
Last updated
04/24/2017
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