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NPI Code Detail

MEDICARE: DONALD LYNN GRINER D.O.

MEDICARE: DONALD LYNN GRINER 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
1207Q00000XFamily Medicine Physician2273AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AZ0878700OTHERAZBLUE CROSS BLUE SHIELD
21Z1015OTHERAZHEALTHNET
3621571OTHERAZAETNA

General Provider Information

NPI Number : 1821091497
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONALD LYNN GRINER D.O.
Provider Business Mailing Address
First Line : 3048 E BASELINE RD
Second Line : STE 109
City : MESA
State : AZ
Zip : 85204-7286
Country : US
Telephone Number : 480-632-1117
Fax Number : 480-632-1118
Provider Business Practice Location Address
First Line : 3048 E BASELINE RD
Second Line : STE 109
City : MESA
State : AZ
Zip : 85204-7287
Country : US
Telephone Number : 480-632-1117
Fax Number : 480-632-1118
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 02/27/2015

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