Individual
DR. DOUGLAS JAMES GRIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 981-7271
Mailing address
PO BOX 21569, ROANOKE, VA 24018-0568
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
0101247057
VA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
0101247057
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184684581
—
VA
05
—
3810017221
—
WV
01
—
P00836588
RAILROAD MEDICARE
—
Enumeration date
03/28/2006
Last updated
03/08/2016
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