Provider Demographics
NPI:1699071415
Name:GRIESSER, WILLIAM T
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:T
Last Name:GRIESSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W. ENT AVE
Mailing Address - Street 2:ATTN: 21 MDOS/SGOF - FAM HLTH
Mailing Address - City:PETERSON AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1540
Mailing Address - Country:US
Mailing Address - Phone:719-556-4931
Mailing Address - Fax:866-867-7926
Practice Address - Street 1:110 W. ENT AVE
Practice Address - Street 2:ATTN: 21 MDOS/SGOF - FAM HLTH
Practice Address - City:PETERSON AFB
Practice Address - State:CO
Practice Address - Zip Code:80914-1540
Practice Address - Country:US
Practice Address - Phone:719-556-4931
Practice Address - Fax:866-867-7926
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant