Healthcare Provider Details

I. General information

NPI: 1215909809
Provider Name (Legal Business Name): STEVEN D GRIJALVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: STEVEN DIONISIO GRIJALVA MD

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N STATE OF FRANKLIN RD STE 140
JOHNSON CITY TN
37604-6972
US

IV. Provider business mailing address

1021 W OAKLAND AVE STE 310
JOHNSON CITY TN
37604-2192
US

V. Phone/Fax

Practice location:
  • Phone: 423-431-2460
  • Fax:
Mailing address:
  • Phone: 423-952-2111
  • Fax: 423-282-1657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number88491
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number65127
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: