MEDICARE: DR. JUDY GRISHABER D.O.

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	207ZB0001X	Blood Banking & Transfusion Medicine Physician	2007003901	MO

General Provider Information

NPI Number	:	1164668364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDY GRISHABER D.O.

Provider Business Mailing Address
First Line	:	4050 LINDELL BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-3202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 LINDELL BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-3202
Country	:	US
Telephone Number	:	314-658-8691
Fax Number	:

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

Provider Enumeration Date	:	12/18/2008
Last Update Date	:	12/18/2008

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