Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | K9791 | TX |
NPI | 1356531180 |
---|---|
Provider Name | Dr. C. Keith Grisham |
First Address | Plano, TX 75093-6383 |
Second Address | Plano, TX 75093-6383 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2007 |
Last Update Date | 31/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030393501 | (05) | TX |