Provider Demographics
NPI:1588400691
Name:PAXTON MEDICAL MANAGEMENT
Entity type:Organization
Organization Name:PAXTON MEDICAL MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GROVE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-588-9572
Mailing Address - Street 1:1615 SUN CITY CENTER PLZ
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-5303
Mailing Address - Country:US
Mailing Address - Phone:813-894-7046
Mailing Address - Fax:
Practice Address - Street 1:1615 SUN CITY CENTER PLZ
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5303
Practice Address - Country:US
Practice Address - Phone:813-894-7046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty