Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | ARNP9207097 | FL |
NPI | 1407854383 |
---|---|
Provider Name | William Arthur Grass |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Tampa, FL 33606-3508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 20/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
308331400 | (05) | FL |
Y061EY | MEDICARE GTBA REASSIGN (01) | FL |