MEDICARE: NIMA A GRISSOM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	C38970	CA

General Provider Information

NPI Number	:	1144391897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIMA A GRISSOM MD

Provider Business Mailing Address
First Line	:	3801 SACRAMENTO ST
Second Line	:	SUITE 100
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1625
Country	:	US
Telephone Number	:	415-600-1817
Fax Number	:	415-600-1974

Provider Business Practice Location Address
First Line	:	3700 SACRAMENTO ST
Second Line	:	#100
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1706
Country	:	US
Telephone Number	:	415-292-8999
Fax Number	:	415-292-8990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	11/27/2012

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