Healthcare Provider Details

I. General information

NPI: 1285581009
Provider Name (Legal Business Name): DAVID JOSEPH GRISHAM PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 475 OFFICE 409
APO AE
92655
US

IV. Provider business mailing address

PSC 415 BOX 4346
APO AE
09114-0044
US

V. Phone/Fax

Practice location:
  • Phone: 637-590-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1246099
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: