Gordon Grenn D.O., P.a.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS0003345 Issued in FL

Legal business name

GORDON GRENN D.O., P.A.

Practice address

4002 Raulerson Dr
Lake Worth, FL 33463-8927

Phone

(561) 964-4077

Fax

(561) 964-9296

NPI assigned

Nov 2, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gordon L. Grenn, D.O.NPI 1871603670

Title

Doctor

Phone

(561) 964-4077

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Networks

• HealthSun Health Plans Network

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gordon L Grenn

  • Family Medicine Physician
  • Lake Worth, FL
  • NPI 1871603670
  Medicare reassignment NPD Authorized official
• Sherri Jensen, ARNP

  • Geriatric Medicine (Family Medicine) Physician
  • Greenacres, FL
  • NPI 1407187552
  NPD (past)
• Editha Angelita Pangan, MD

  • Internal Medicine Physician
  • Wellington, FL
  • NPI 1720165749
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305590400000",
    "number": "1326348681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4002 RAULERSON DR",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334638927",
            "telephone_number": "561-964-4077",
            "fax_number": "561-964-9296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4002 RAULERSON DR",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334638927",
            "telephone_number": "561-964-4077",
            "fax_number": "561-964-9296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GORDON GRENN D.O., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-02",
        "last_updated": "2011-05-17",
        "status": "A",
        "authorized_official_last_name": "GRENN",
        "authorized_official_first_name": "GORDON",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "561-964-4077",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS0003345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "265885200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evelyne Goode, B.S
• Ryan Goodkin
• Norman Goodman
• Laurie D Goodwin, PTA
• Mary Gopeesingh
• Amy Gordon, LCSW
• Marla Goren, M.A./CCC-SLP
• Michael Gott, DMD
• Grace Assisted Living Facility LLC
• Graceful Home Care Services, LLC

• Family Medicine Physician in Lake Worth, FL
• Providers in Lake Worth, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.