Provider Demographics
NPI:1497186845
Name:GRIZ, JOHN M (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:GRIZ
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 1:22971 HWY 76E
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325
Mailing Address - Country:US
Mailing Address - Phone:864-833-3046
Mailing Address - Fax:864-833-1711
Practice Address - Street 1:22971 HWY 76E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325
Practice Address - Country:US
Practice Address - Phone:864-833-3046
Practice Address - Fax:864-833-1711
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10228207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC102285Medicaid
SC0121480001Medicare NSC
SC102285Medicaid