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General NPI Number Information
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NPI Number | 1679954655
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Entity Type | Individual
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Provider Name | JOHN RUSSELL GRIGGS DO
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Gender | Male
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 3101 SE 14TH ST
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City | BENTONVILLE
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State | AR
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Zip | 72712-4900
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Country | US
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Telephone | 479-250-1053
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Fax | 479-250-0923
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Provider Business Mailing Address
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Address Line | 3101 SE 14TH ST
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City | BENTONVILLE
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State | AR
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Zip | 72712-4900
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Country | US
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Telephone | 479-250-1053
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Fax | 479-250-0923
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 02005361A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E-15842
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License Number State | AR
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