Individual
JOHN RUSSELL GRIGGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3101 SE 14TH ST, BENTONVILLE, AR 72712-4900
(479) 250-1053
(479) 250-0923
Mailing address
3101 SE 14TH ST, BENTONVILLE, AR 72712-4900
(479) 250-1053
(479) 250-0923
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
02005361A
IN
207Q00000X
Family Medicine Physician
Primary
E-15842
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300016168
—
IN
Enumeration date
06/15/2015
Last updated
04/05/2023
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