Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | OS9490 | FL |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS9490 | FL |
Y | 207QS0010X | Family Doctor - Sports Medicine | OS9490 | FL |
NPI | 1588680821 |
---|---|
Provider Name | Dr. Daniel Grobman |
First Address | Fort Lauderdale, FL 33301-3516 |
Second Address | Pompano Beach, FL 33060-6345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 19/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H78284 | (02) | FL |