Individual
DR. JD GRISTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1640 HOSPITAL DR, SANTA FE, NM 87505-4754
(505) 983-9350
(505) 955-8763
Mailing address
1640 HOSPITAL DR, SANTA FE, NM 87505-4754
(505) 983-9350
(505) 955-8763
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
94-258
NM
2085R0202X
Diagnostic Radiology Physician
94-258
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20568
—
NM
Enumeration date
07/20/2006
Last updated
03/18/2008
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