| Entity Name: | GORDON GRENN, D.O., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 01 Nov 1977 (47 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 25 Sep 1995 (29 years ago) |
| Document Number: | 549854 |
| FEI/EIN Number | 59-1773343 |
| Address: | C/O GORDON GRENN, 4002 RAULERSON ROAD, LAKE WORTH, FL 33463 |
| Mail Address: | C/O GORDON GRENN, 4002 RAULERSON ROAD, LAKE WORTH, FL 33463 |
| ZIP code: | 33463 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1326348681 | 2010-11-02 | 2011-05-17 | 4002 RAULERSON DR, LAKE WORTH, FL, 334638927, US | 4002 RAULERSON DR, LAKE WORTH, FL, 334638927, US | |||||||||||||||||||||||||
|
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| Phone | +1 561-964-4077 |
| Fax | 5619649296 |
Authorized person
| Name | DR. GORDON L. GRENN |
| Role | DOCTOR |
| Phone | 5619644077 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | OS0003345 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 265885200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GRENN, GORDON | Agent | 4002 RAULERSON ROAD, LAKE WORTH, FL 33463 |
| Name | Role | Address |
|---|---|---|
| GRENN, GORDON L. | dr | C/O GORDON GRENN, 4002 RAULERSON ROAD LAKE WORTH, FL 33463 |
| Name | Role | Address |
|---|---|---|
| GRENN, JUDITH B. | Secretary | 3755 CANTERBURY WAY, BOCA RATON, FL |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 1995-09-25 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1995-08-25 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 1986-07-17 | GRENN, GORDON | No data |
| NAME CHANGE AMENDMENT | 1986-07-17 | GORDON GRENN, D.O., P.A. | No data |
| CHANGE OF PRINCIPAL ADDRESS | 1986-03-20 | C/O GORDON GRENN, 4002 RAULERSON ROAD, LAKE WORTH, FL 33463 | No data |
| CHANGE OF MAILING ADDRESS | 1986-03-20 | C/O GORDON GRENN, 4002 RAULERSON ROAD, LAKE WORTH, FL 33463 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 1986-03-20 | 4002 RAULERSON ROAD, LAKE WORTH, FL 33463 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-09 |
| ANNUAL REPORT | 2023-02-13 |
| ANNUAL REPORT | 2022-01-24 |
| ANNUAL REPORT | 2021-02-26 |
| ANNUAL REPORT | 2020-02-07 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-02-09 |
| ANNUAL REPORT | 2016-02-06 |
| ANNUAL REPORT | 2015-04-11 |
Date of last update: 05 Feb 2025
Sources: Florida Department of State
