Healthcare Provider Details

I. General information

NPI: 1578050266
Provider Name (Legal Business Name): WILLIAM SPENCER GRIGG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W 6TH ST
MOUNTAIN HOME AR
72653-3409
US

IV. Provider business mailing address

PO BOX 707
MOUNTAIN HOME AR
72654-0707
US

V. Phone/Fax

Practice location:
  • Phone: 870-425-8288
  • Fax: 870-425-8299
Mailing address:
  • Phone: 870-424-7070
  • Fax: 870-424-6616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL.0007279
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTL.0007279
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0062850
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0062850
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberE18962
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: