Provider Demographics
NPI:1245216951
Name:GRIESER, RICHARD J (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:GRIESER
Suffix:
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 1:735 S SHOOP AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-1735
Mailing Address - Country:US
Mailing Address - Phone:419-335-3242
Mailing Address - Fax:419-335-3222
Practice Address - Street 1:735 S SHOOP AVE
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1735
Practice Address - Country:US
Practice Address - Phone:419-335-3242
Practice Address - Fax:419-335-3222
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 35 0676 G207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0570538Medicaid
A15864Medicare UPIN
0554194Medicare PIN