Grissom, John Thomas

Grissom, John Thomas is an individual health care provider with primary practice located at 3066 E Meridian Park Loop # 1 , Wasilla AK 99654-7299. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Interventional Pain Medicine, Allopathic & Osteopathic Physicians / Anesthesiology. Allopathic & Osteopathic Physicians / Interventional Pain Medicine is his primary health care specialty. Grissom, John Thomas can be contacted via phone (907) 373-9460.

Contact Information

Primary practice address
3066 E Meridian Park Loop # 1 Wasilla AK 99654-7299
Phone: (907) 373-9460
Fax: (907) 373-9461
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Interventional Pain Medicine 208VP0014X M-7402 Idaho
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 6558 Alaska
Allopathic & Osteopathic Physicians / Interventional Pain Medicine 208VP0014X 6558 Alaska

Profile Details

NPI number 1598789513
LBN Legal business name Grissom, John Thomas
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 26th, 2006
Last updated Nov 5th, 2012 - about 13 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 1598789513 NPPES
Alaska MEDICAID MD0853

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