Provider Demographics
NPI:1962542449
Name:WILLIAM S GRUSS MD PA
Entity type:Organization
Organization Name:WILLIAM S GRUSS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:STEVE
Authorized Official - Last Name:GRUSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-289-7724
Mailing Address - Street 1:9858 GLADES RD
Mailing Address - Street 2:#155
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3983
Mailing Address - Country:US
Mailing Address - Phone:561-289-7724
Mailing Address - Fax:561-470-8620
Practice Address - Street 1:9858 GLADES RD
Practice Address - Street 2:#155
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3983
Practice Address - Country:US
Practice Address - Phone:561-289-7724
Practice Address - Fax:561-470-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041671207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96559Medicare PIN
FLD63899Medicare UPIN