Healthcare Provider Details

I. General information

NPI: 1649352246
Provider Name (Legal Business Name): JOHN EDGAR GRIGGS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 CAREW ST SUITE 434
SPRINGFIELD MA
01104-2301
US

IV. Provider business mailing address

299 CAREW ST SUITE 434
SPRINGFIELD MA
01104-2301
US

V. Phone/Fax

Practice location:
  • Phone: 413-737-2981
  • Fax: 413-737-1366
Mailing address:
  • Phone: 413-737-2981
  • Fax: 413-737-1366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number47626
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: