Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | ME102652 | FL |
NPI | 1144438219 |
---|---|
Provider Name | Dr. Elvis L Grandic |
First Address | Boynton Beach, FL 33435-7944 |
Second Address | Boynton Beach, FL 33435-7944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2007 |
Last Update Date | 28/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000188900 | (05) | FL |