Healthcare Provider Details

I. General information

NPI: 1003033713
Provider Name (Legal Business Name): LISA MARIE GRISS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA MARIE WHITE MD

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 06/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 E 19TH AVE
DENVER CO
80218-1235
US

IV. Provider business mailing address

1719 E 19TH AVE
DENVER CO
80218-1235
US

V. Phone/Fax

Practice location:
  • Phone: 303-754-4400
  • Fax:
Mailing address:
  • Phone: 720-754-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47937
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: