Provider Demographics
NPI:1386757193
Name:GRASLEY, ANDREW BARNES (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:BARNES
Last Name:GRASLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 SW BALLSTON ROAD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:OR
Mailing Address - Zip Code:97378
Mailing Address - Country:US
Mailing Address - Phone:503-843-6444
Mailing Address - Fax:
Practice Address - Street 1:2702 SW BALLSTON ROAD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:OR
Practice Address - Zip Code:97378
Practice Address - Country:US
Practice Address - Phone:503-843-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20115208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORG45238Medicare UPIN