Individual
JACK W GRINNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2530 E SOUTHERN AVE, MESA, AZ 85204-5411
(480) 834-4188
(480) 834-6181
Mailing address
10200 GRAND CENTRAL AVE STE 220, OWINGS MILLS, MD 21117-4366
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
55776
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
372496
—
AZ
Enumeration date
05/20/2013
Last updated
03/21/2025
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