Individual
DR. FERNANDO GRIGERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
777 HOSPITAL WAY BLDG A, STE. 101, POCATELLO, ID 83201-2753
(208) 234-2001
(208) 232-2195
Mailing address
PO BOX 4168, POCATELLO, ID 83205-4168
(208) 234-2001
(208) 232-2195
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
M9142
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806974000
—
ID
Enumeration date
09/26/2005
Last updated
11/07/2011
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