Individual
JOHN DALE GRIZZLE II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15800 S WESTERN AVE, OKLAHOMA CITY, OK 73170-9393
(405) 793-1300
(405) 805-6611
Mailing address
15800 S WESTERN AVE, OKLAHOMA CITY, OK 73170-9393
(405) 793-1300
(405) 805-6611
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
20170
OK
207Q00000X
Family Medicine Physician
Primary
20170
OK
207QA0401X
Addiction Medicine (Family Medicine) Physician
20170
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080136148
RAILROAD
OK
05
—
100113130C
—
OK
01
—
20170
LICENSE
OK
01
—
244431002
MEDICARE ID
OK
01
—
25263
OBNDD
OK
01
—
731381689GRI
PREMIERE
OK
Enumeration date
04/18/2006
Last updated
10/15/2025
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