10D0288488 CLIA NUMBER - GORDON GRENN DO PA

Laboratory Demographics

  • CLIA Code: 10D0288488
  • Facility Name: GORDON GRENN DO PA
  • Facility Address: 4002 RAULERSON DR
    LAKE WORTH, FL
    ZIP 33463
  • Facility Phone: 561 964-4077
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GORDON GRENN DO
  • NPI Number: 1871603670
  • Taxonomy: 207Q00000X - Family Medicine

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/23/2025
Certificate Expiration Date 5/22/2027
Facility Type Physician Office
Lab Director GORDON GRENN DO

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This page was last updated on: 9/29/2025