Individual
DR. LESLIE E. GRISSOM
Active
Individual
DR. LESLIE E. GRISSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
Primary
C10002480
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1165522
—
LA
05
—
1197564
—
PA
05
—
1437681
—
NY
05
—
510123
—
IA
05
—
5166608
—
NJ
05
—
64195951
—
KY
05
—
7709013
—
MD
05
—
806321200
—
ID
05
—
XPY196074
—
CA
Enumeration date
09/29/2006
Last updated
02/04/2013
Update your record
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