Healthcare Provider Details

I. General information

NPI: 1871895375
Provider Name (Legal Business Name): GERMAN GHENA GRINSHPUN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE MADIGAN ARMY MEDICAL CENTER
TACOMA WA
98431-0001
US

IV. Provider business mailing address

9040 JACKSON AVE MADIGAN ARMY MEDICAL CENTER
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-5165
  • Fax:
Mailing address:
  • Phone: 253-968-2543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number257111-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number257111
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: