Individual
JOHN O GROOMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
950 N AVALON WAY, LECANTO, FL 34461-6004
(352) 746-2663
(352) 746-6907
Mailing address
PO BOX 1990, CRYSTAL RIVER, FL 34423-1990
(352) 746-2663
(352) 746-6907
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA3291
FL
363AM0700X
Medical Physician Assistant
PA3291
FL
363AS0400X
Surgical Physician Assistant
PA3291
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
292891400
—
FL
Enumeration date
01/30/2007
Last updated
03/15/2011
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