Provider Demographics
NPI:1215909809
Name:GRIJALVA, STEVEN D (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:GRIJALVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STEVEN
Other - Middle Name:DIONISIO
Other - Last Name:GRIJALVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:840 PINE ST STE 500
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7530
Mailing Address - Country:US
Mailing Address - Phone:478-633-8682
Mailing Address - Fax:478-633-8698
Practice Address - Street 1:840 PINE ST STE 500
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7530
Practice Address - Country:US
Practice Address - Phone:478-633-8682
Practice Address - Fax:478-633-8698
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA88491207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery