Healthcare Provider Details

I. General information

NPI: 1508000381
Provider Name (Legal Business Name): JEFFERY RYAN GRIZZAFFI D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WILSON ST STE C-2
LAFAYETTE LA
70503-2439
US

IV. Provider business mailing address

901 WILSON ST STE C-2
LAFAYETTE LA
70503-2439
US

V. Phone/Fax

Practice location:
  • Phone: 337-232-3576
  • Fax: 337-233-2816
Mailing address:
  • Phone: 337-232-3576
  • Fax: 337-233-2816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPM200025
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: