Individual
JEFFREY DALE GRILLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2601 GENE GEORGE BLVD, SPRINGDALE, AR 72762
(479) 725-6977
(479) 725-6577
Mailing address
1 CHILDRENS WAY # 844, LITTLE ROCK, AR 72202-3500
(501) 364-2090
(501) 364-3929
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
112085
MO
208000000X
Pediatrics Physician
Primary
E10930
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100250370B
—
OK
05
—
100289710A
—
KS
01
—
107500
ANTHEM
MO
05
—
208684605
—
MO
05
—
224757001
—
AR
Enumeration date
06/27/2006
Last updated
03/22/2018
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