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General NPI Number Information
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NPI Number | 1740369636
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Entity Type | Individual
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Provider Name | SCOTT MARTIN GRIGORY M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 1 W MAIN ST SUITE 100
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City | IDABEL
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State | OK
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Zip | 74745-4654
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Country | US
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Telephone | 580-579-3385
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Fax |
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Provider Business Mailing Address
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Address Line | ONE WEST MAIN SUITE 100
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City | IDABEL
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State | OK
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Zip | 74745-4655
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Country | US
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Telephone | 580-286-1101
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Fax | 580-286-5566
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25241
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License Number State | OK
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