Provider Demographics
NPI:1720062789
Name:GRISWOLD, JOHN ANTHONY JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:GRISWOLD
Suffix:JR
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:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-2787
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0002
Practice Address - Country:US
Practice Address - Phone:806-743-2373
Practice Address - Fax:806-743-4354
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1419208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM201015993Medicaid
NMA039OtherTRIWEST
TX114085101Medicaid
TX80840ZOtherHMO BLUE
TX83G204OtherBC/BS
OK100204440AMedicaid
TX114085100OtherFIRSTCARE COMMERCIAL
TX125354403Medicaid
NM201015993OtherPRESBYTERIAN COMMERCIAL
TX125354402Medicaid
NMY0224Medicaid
NM201015993OtherPRESBYTERIAN COMMERCIAL
TX83G204OtherBC/BS
NMY0224Medicaid