Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | OS4832 | FL |
NPI | 1174586515 |
---|---|
Provider Name | Dr. Alan Keith Gruskin |
First Address | Tamarac, FL 33321-2979 |
Second Address | Tamarac, FL 33321-2979 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 08/07/2007 |