Provider Demographics
NPI:1518279595
Name:GRISHAM, JOEL MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:MARK
Last Name:GRISHAM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5209 WESTLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3326
Mailing Address - Country:US
Mailing Address - Phone:702-878-9665
Mailing Address - Fax:702-878-9665
Practice Address - Street 1:10837 LAUREL ST
Practice Address - Street 2:101
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7643
Practice Address - Country:US
Practice Address - Phone:562-208-1600
Practice Address - Fax:909-481-3679
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAC39296208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)