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Contact Information

JOHN T GRISSOM II, MD
3066 E MERIDIAN PARK LOOP # 1
WASILLA, AK99654-7299
 Phone: 907-373-9460
 Fax: 907-373-9461
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Interventional Pain Medicine

208VP0014X 09 Physician/Interventional Pain Management
 

Anesthesiology

207L00000X 79 Physician/Addiction Medicine
Indicates primary specialty

NPI Profile & details for JOHN T GRISSOM II · (Male)

NPI Number 1598789513
Status Active
Credentials MD
Entity Individual
Enumeration date 07/26/2006
Last updated 11/05/2012 - About 14 years ago
Sole proprietor 1 No
Identifiers
  • AK License # 6558
  • ID License # M-7402
  • AK Medicaid MD0853
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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