Provider Demographics
NPI:1003254483
Name:GRAMMY, JUSTIN N (DO)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:N
Last Name:GRAMMY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 12460
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-2460
Mailing Address - Country:US
Mailing Address - Phone:805-543-4407
Mailing Address - Fax:805-543-4587
Practice Address - Street 1:1428 PHILLIPS LN STE 203
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2551
Practice Address - Country:US
Practice Address - Phone:805-543-4407
Practice Address - Fax:805-543-4587
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018634207R00000X
CA16620207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine