10D0288488 CLIA NUMBER - GORDON GRENN DO PA

Laboratory Demographics

CLIA Number: 10D0288488

Facility Name: GORDON GRENN DO PA

Facility Address:
4002 RAULERSON DR
LAKE WORTH, FL
ZIP 33463
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Facility Phone Number: 561 964-4077

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1871603670

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	10D0288488
LAB Type	Physician Office
Facility Name	GORDON GRENN DO PA
Street	4002 RAULERSON DR
City	LAKE WORTH
State	FL
ZIP	33463
Phone	561 964-4077
CertificateType	4
CertificateEffectiveDate	5/23/2023
CertificateExpirationDate	5/22/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024