Healthcare Provider Details

I. General information

NPI: 1710985478
Provider Name (Legal Business Name): WILLIAM S GRIZZARD JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 JENNICK DR
COLONIAL HEIGHTS VA
23834-4901
US

IV. Provider business mailing address

439 JENNICK DR
COLONIAL HEIGHTS VA
23834-4901
US

V. Phone/Fax

Practice location:
  • Phone: 804-524-0890
  • Fax: 804-524-0897
Mailing address:
  • Phone: 804-524-0890
  • Fax: 804-524-0897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101036157
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: