Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 12405 | OK |
NPI | 1598761736 |
---|---|
Provider Name | Joseph Grillo |
First Address | Oklahoma City, OK 73109 |
Second Address | Oklahoma City, OK 73109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 14/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D39152 | (02) | OK |