Destin Vein Center LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME92186 Issued in FL

Legal business name

DESTIN VEIN CENTER LLC

Practice address

4485 Furling LN
Destin, FL 32541-5331

Phone

(850) 654-5222

Fax

(850) 637-8020

NPI assigned

Nov 15, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Richard J Grisoli, MD

Title

Owner

Phone

(850) 654-5222

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492992000000",
    "number": "1902087281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4485 FURLING LN",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325415331",
            "telephone_number": "850-654-5222",
            "fax_number": "850-637-8020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4485 FURLING LN",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325415331",
            "telephone_number": "850-654-5222",
            "fax_number": "850-637-8020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTIN VEIN CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-15",
        "last_updated": "2017-04-24",
        "status": "A",
        "authorized_official_last_name": "GRISOLI",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-654-5222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME92186",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "ME92186",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Destin, FL
• Providers in Destin, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.