Healthcare Provider Details

I. General information

NPI: 1952328494
Provider Name (Legal Business Name): ERIC J GRIGSBY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 VILLA LN SUITE 150
NAPA CA
94558-6405
US

IV. Provider business mailing address

PO BOX 5510
NAPA CA
94581-0510
US

V. Phone/Fax

Practice location:
  • Phone: 707-252-9666
  • Fax: 707-258-2780
Mailing address:
  • Phone: 707-252-9666
  • Fax: 707-258-2780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberG648480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: