Healthcare Provider Details

I. General information

NPI: 1578050266
Provider Name (Legal Business Name): WILLIAM SPENCER GRIGG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 07/22/2024
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVENUE BOX 679
ROCHESTER NY
14642
US

IV. Provider business mailing address

601 ELMWOOD AVENUE BOX 679
ROCHESTER NY
14642
US

V. Phone/Fax

Practice location:
  • Phone: 858-275-4290
  • Fax: 585-473-1573
Mailing address:
  • Phone: 858-275-4290
  • Fax: 585-473-1573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTL.0007279
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0062850
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL.0007279
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0062850
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: