Provider Demographics
NPI:1861051369
Name:JESUS A GROSO MD
Entity type:Organization
Organization Name:JESUS A GROSO MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:A
Authorized Official - Last Name:GROSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-447-1343
Mailing Address - Street 1:2856 NE 54TH TRL
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-8609
Mailing Address - Country:US
Mailing Address - Phone:863-447-1343
Mailing Address - Fax:
Practice Address - Street 1:1008 N PARROTT AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-2110
Practice Address - Country:US
Practice Address - Phone:863-447-1343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-08
Last Update Date:2019-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty