Grisham, Andre D

Grisham, Andre D is an individual health care provider with primary practice located at 9250 Sw Hall Blvd , Tigard OR 97223-6721. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Grisham, Andre D can be contacted via phone (503) 221-0161.

Contact Information

Primary practice address
9250 Sw Hall Blvd Tigard OR 97223-6721
Phone: (503) 221-0161
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 29462 South Carolina
Allopathic & Osteopathic Physicians / Surgery 208600000X 38146 Tennessee
Allopathic & Osteopathic Physicians / Surgery 208600000X MD151172 Oregon

Profile Details

NPI number 1629042122
LBN Legal business name Grisham, Andre D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 14th, 2006
Last updated Jul 21st, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629042122 NPPES
Tennessee MEDICAID 3895467
Tennessee Other 4214668
Tennessee MEDICAID 04951725

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