MEDICARE: DR. LEIGH A GRIGGS GARTLAND MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	114646	MO

General Provider Information

NPI Number	:	1952374647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEIGH A GRIGGS GARTLAND MD

Provider Business Mailing Address
First Line	:	10777 SUNSET OFFICE DR
Second Line	:	SUITE 310
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1019
Country	:	US
Telephone Number	:	314-822-5900
Fax Number	:	314-822-5919

Provider Business Practice Location Address
First Line	:	1035 BELLEVUE AVE
Second Line	:	SUITE 400
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-1854
Country	:	US
Telephone Number	:	314-925-4700
Fax Number	:	314-925-4750

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2006
Last Update Date	:	09/17/2010

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