Provider Demographics
NPI:1437467354
Name:GRIGG, ANDERSEN IRVIN (DO)
Entity Type:Individual
Prefix:
First Name:ANDERSEN
Middle Name:IRVIN
Last Name:GRIGG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 TYRUS CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-5541
Mailing Address - Country:US
Mailing Address - Phone:859-523-5274
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF KENTUCKY AND AFFILIATES
Practice Address - Street 2:800 ROSE ST.
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-332-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR16862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology