Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 5101015592 | MI |
NPI | 1013041532 |
---|---|
Provider Name | Randolph Joseph Grierson III |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Ludington, MI 49431-1953 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 04/03/2021 |