Provider Demographics
NPI:1962791475
Name:GRIGSBY, VERDEAN E
Entity type:Individual
Prefix:MRS
First Name:VERDEAN
Middle Name:E
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 CLYDE DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8025
Mailing Address - Country:US
Mailing Address - Phone:903-595-1653
Mailing Address - Fax:
Practice Address - Street 1:1107 CLYDE DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8025
Practice Address - Country:US
Practice Address - Phone:903-595-1653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies