Individual
DR. RICHARD J. GRISOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15790 PAUL VEGA MD DR, HAMMOND, LA 70403-1434
(985) 345-8867
(985) 542-5322
Mailing address
93 BOGUE FALAYA DR, COVINGTON, LA 70433-4303
(985) 230-6688
(985) 230-6176
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
ME92186
FL
207L00000X
Anesthesiology Physician
Primary
016201
LA
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
016201
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1337781
—
LA
Enumeration date
06/16/2005
Last updated
04/24/2017
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