Grizzle, John Dale
Grizzle, John Dale is an individual health care provider with primary practice located at 5701 N Portland Ave Ste 126 , Oklahoma City OK 73112-1673. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Grizzle, John Dale can be contacted via phone (405) 317-1266.Contact Information
Primary practice address
5701 N Portland Ave Ste 126
Oklahoma City OK 73112-1673
Phone: (405) 317-1266
Fax: (405) 604-6007
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | 20170 | Oklahoma |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 20170 | Oklahoma |
Profile Details
| NPI number | 1255396073 |
|---|---|
| LBN Legal business name | Grizzle, John Dale |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 18th, 2006 |
| Last updated | Oct 2nd, 2018 - about 6 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1255396073 | NPPES |
| Oklahoma | Other | 731381689GRI | PREMIERE |
| Oklahoma | Other | 080136148 | PREMIERE |
| Oklahoma | MEDICAID | 100113130C | PREMIERE |
| Oklahoma | Other | 244431002 | PREMIERE |
| Oklahoma | Other | 20170 | PREMIERE |
| Oklahoma | Other | 25263 | PREMIERE |
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