Provider Demographics
NPI:1114079589
Name:GRILEY, EDMUND A (MD)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:A
Last Name:GRILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EDMUND
Other - Middle Name:A
Other - Last Name:GRILEY GUEVARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 315574
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-3474
Mailing Address - Country:US
Mailing Address - Phone:671-646-6111
Mailing Address - Fax:671-646-6115
Practice Address - Street 1:#138 YPAO ROAD
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96931
Practice Address - Country:US
Practice Address - Phone:671-646-6111
Practice Address - Fax:671-646-6115
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM00714207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU027Medicaid