Provider Demographics
NPI:1407802838
Name:GRIGGS, DAVID NORMAN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:NORMAN
Last Name:GRIGGS
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:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-0137
Mailing Address - Country:US
Mailing Address - Phone:253-697-5502
Mailing Address - Fax:253-697-5510
Practice Address - Street 1:1518 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-1812
Practice Address - Country:US
Practice Address - Phone:253-697-7400
Practice Address - Fax:253-863-8518
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027971208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA911203494BOOtherKPS PROVIDER NUMBER
WA9869GROtherREGENCE RIDER NUMBER
WA1060482Medicaid
WA4363951OtherAETNA PROVIDER NUMBER
WA98390A016OtherTRICARE PROVIDER NUMBER
WA0186827OtherL & I PROVIDER NUMBER
A40771Medicare UPIN