Individual
ROGER DEAN GRIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
120 E ADAMS ST, STE 4, LAGRANGE, KY 40031-1278
(502) 222-3281
(502) 225-5796
Mailing address
120 E ADAMS ST, STE 4, LAGRANGE, KY 40031-1278
(502) 222-3281
(502) 225-5796
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
19015
KY
2085N0904X
Nuclear Radiology Physician
19015
KY
2085R0202X
Diagnostic Radiology Physician
Primary
19015
KY
2085U0001X
Diagnostic Ultrasound Physician
19015
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64190150
—
KY
Enumeration date
07/07/2006
Last updated
11/09/2007
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