Healthcare Provider Details

I. General information

NPI: 1245248475
Provider Name (Legal Business Name): ROBERT LEE GRIGSBY III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 DOCTORS VILLAGE DR
ST JOHNS FL
32259-2245
US

IV. Provider business mailing address

150 GRAFFT LN
ST AUGUSTINE FL
32084-6557
US

V. Phone/Fax

Practice location:
  • Phone: 904-230-5000
  • Fax:
Mailing address:
  • Phone: 850-585-5285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME34609
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME34609
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: