Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 23437 | AZ |
Y | 207W00000X | Ophthalmologist | MD14713 | OR |
NPI | 1033122627 |
---|---|
Provider Name | Mr. Nicholas Peter Grinich |
First Address | Mcminnville, OR 97128-8479 |
Second Address | Mcminnville, OR 97128-8479 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 02/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
026562 | (05) | OR |
E57874 | (02) |