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General NPI Number Information
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NPI Number | 1336200039
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Entity Type | Individual
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Provider Name | MARK LESLIE GRISWOLD D.O.
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Gender | Male
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 1521 E TANGERINE RD SUITE 301
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City | ORO VALLEY
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State | AZ
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Zip | 85755-6225
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Country | US
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Telephone | 520-797-9700
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Fax | 520-797-0600
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Provider Business Mailing Address
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Address Line | PO BOX 69610
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City | TUCSON
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State | AZ
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Zip | 85737-0019
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Country | US
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Telephone | 520-797-9700
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Fax | 520-797-0600
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 2799
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License Number State | AZ
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