Individual
JOHN THOMAS GRISSOM II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3066 E MERIDIAN PARK LOOP # 1, WASILLA, AK 99654-7299
(907) 373-9460
(907) 373-9461
Mailing address
PO BOX 951027, SOUTH JORDAN, UT 84095-1027
(907) 373-9460
(907) 373-9461
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
6558
AK
208VP0014X
Interventional Pain Medicine Physician
Primary
6558
AK
208VP0014X
Interventional Pain Medicine Physician
M-7402
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MD0853
—
AK
Enumeration date
07/26/2006
Last updated
11/05/2012
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