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General NPI Number Information
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NPI Number | 1184684581
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Entity Type | Individual
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Provider Name | DOUGLAS JAMES GRIDER MD
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Gender | Male
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 03/08/2016
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Provider Practice Location Address
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Address Line | 1906 BELLEVIEW AVE SE
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City | ROANOKE
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State | VA
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Zip | 24014-1838
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Country | US
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Telephone | 540-981-7271
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 21569
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City | ROANOKE
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State | VA
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Zip | 24018-0568
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 0101247057
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | 0101247057
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License Number State | VA
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