| Entity Name: | BRUCE M. GROSSMAN, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 31 Oct 1990 (34 years ago) |
| Date of dissolution: | 25 Sep 2009 (15 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2009 (15 years ago) |
| Document Number: | S09823 |
| FEI/EIN Number | N/A |
| Address: | 3370 BURNS RD, SUITE 105, PALM BEACH GARDENS, FL 33410 |
| Mail Address: | 2316 PALM HARBOUR DR, PALM BEACH GARDENS, FL 33410 |
| ZIP code: | 33410 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033381280 | 2008-03-27 | 2008-06-07 | 3370 BURNS RD, 105, PALM BEACH GARDENS, FL, 334104327, US | 3370 BURNS RD, 105, PALM BEACH GARDENS, FL, 334104327, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 561-691-9660 |
| Fax | 5616919633 |
Authorized person
| Name | LOIS T CARLISLE |
| Role | OFFICE MANAGER |
| Phone | 5616919660 |
Taxonomy
| Taxonomy Code | 207RG0100X - Gastroenterology Physician |
| License Number | 0053017 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 049666900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GROSSMAN, BRUCE M. | Agent | 2316 PALM HARBOR DR, WEST PALM BEACH, FL 33410 |
| Name | Role | Address |
|---|---|---|
| GROSSMAN, BRUCE M | President | 2316 PALMHARBOR DR, WEST PALM BEACH, FL 33410 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2008-01-28 | 3370 BURNS RD, SUITE 105, PALM BEACH GARDENS, FL 33410 | No data |
| CHANGE OF MAILING ADDRESS | 2008-01-16 | 3370 BURNS RD, SUITE 105, PALM BEACH GARDENS, FL 33410 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2003-01-21 | 2316 PALM HARBOR DR, WEST PALM BEACH, FL 33410 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2008-01-16 |
| ANNUAL REPORT | 2007-01-09 |
| ANNUAL REPORT | 2006-01-13 |
| ANNUAL REPORT | 2005-01-31 |
| ANNUAL REPORT | 2004-02-04 |
| ANNUAL REPORT | 2003-01-21 |
| ANNUAL REPORT | 2002-03-19 |
| ANNUAL REPORT | 2001-02-19 |
| ANNUAL REPORT | 2000-02-08 |
| ANNUAL REPORT | 1999-03-24 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
