Provider Demographics
NPI:1568414878
Name:GRILL, JEFFREY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:GRILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1112 E MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2611
Mailing Address - Country:US
Mailing Address - Phone:602-258-4951
Mailing Address - Fax:602-340-1853
Practice Address - Street 1:5757 W THUNDERBIRD RD STE W202
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-5612
Practice Address - Country:US
Practice Address - Phone:602-298-1932
Practice Address - Fax:602-862-1131
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ31092207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ751778Medicaid
AZF13810Medicare UPIN
73688Medicare ID - Type Unspecified
AZZ149506Medicare PIN