Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 04-35762 | KS |
NPI | 1013166354 |
---|---|
Provider Name | Dr. Joel Kent Grigsby |
First Address | Kansas City, MO 64141-1851 |
Second Address | Kansas City, KS 66160-8500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2008 |
Last Update Date | 25/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0055510 | (05) | OH |