Individual
MARK ANDREW GRISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5151 N 9TH AVE STE 200, PENSACOLA, FL 32504-8721
(850) 416-4970
Mailing address
PO BOX 2699, PENSACOLA, FL 32513-2699
(850) 475-4500
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
ME95178
FL
207RI0011X
Interventional Cardiology Physician
Primary
ME110993
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05483588
—
MS
05
—
1140619
—
LA
01
—
ME95178
MEDICAL LICENSE
FL
Enumeration date
06/22/2006
Last updated
07/21/2022
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