Individual
DR. THOMAS D. GRISHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
232 S WOODS MILL RD, CHESTERFIELD, MO 63017-3417
(314) 205-6990
Mailing address
3 WOODBINE CT, WASHINGTON, MO 63090-5614
(636) 583-2786
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R3J37
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202604559
—
MO
01
—
P00374184
RR MEDICARE
MO
Enumeration date
07/20/2006
Last updated
02/10/2012
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