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General NPI Number Information
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NPI Number | 1780902155
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Entity Type | Organization
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Legal Business Name | RAYMOND F. GRENFELL, III., M.D., PLLC
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Dates
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Enumeration Date | 05/11/2010
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Last Update Date | 05/11/2010
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Provider Practice Location Address
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Address Line | 971 LAKELAND DRIVE SUITE 450
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City | JACKSON
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State | MS
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Zip | 39216
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Country | US
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Telephone | 601-948-5158
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Fax | 601-949-6058
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Provider Business Mailing Address
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Address Line | 971 LAKELAND DR SUITE 450
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City | JACKSON
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State | MS
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Zip | 39216-4643
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Country | US
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Telephone | 601-948-5158
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Fax | 601-949-6058
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Authorized Official
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Title or Position | OWNER
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Name | RAYMOND F GRENFELL III
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Credential | M.D.
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Telephone | 601-948-5158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 21031
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License Number State | MS
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