Individual
JOHN GRISHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11725 W 112TH ST, OVERLAND PARK, KS 66210
(913) 469-5579
Mailing address
PO BOX 741331, ATLANTA, GA 30374-1331
(913) 469-0503
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04-39459
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201147120B
—
KS
Enumeration date
06/04/2015
Last updated
11/08/2018
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