Individual
ALLEN TRACY GRISSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1204 N MOUND ST, RADIOLOGY DEPARTMENT, NACOGDOCHES, TX 75961-4027
(936) 568-8514
(903) 663-0378
Mailing address
PO BOX 5370, LONGVIEW, TX 75608-5370
(903) 663-4800
(903) 663-0378
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
K3580
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
047351401
—
TX
Enumeration date
05/12/2006
Last updated
12/20/2011
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