MEDICARE: DR. ANDREW SCOTT GRIVAS JR.

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	207R00000X	Internal Medicine Physician	016921	GA

General Provider Information

NPI Number	:	1285658815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW SCOTT GRIVAS JR.

Provider Business Mailing Address
First Line	:	1406 MISSOURI BLVD STE I
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-1737
Country	:	US
Telephone Number	:	855-976-1888
Fax Number	:	816-817-0655

Provider Business Practice Location Address
First Line	:	1406 MISSOURI BLVD STE I
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-1737
Country	:	US
Telephone Number	:	855-976-1888
Fax Number	:

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	04/16/2024

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