Provider Demographics
NPI:1568796654
Name:GRIDER, JOHN HAROLD (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HAROLD
Last Name:GRIDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:HAROLD
Other - Last Name:GRIDER
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 742337
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2860 CHANNING WAY STE 221
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7541
Practice Address - Country:US
Practice Address - Phone:208-535-4000
Practice Address - Fax:208-535-4014
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO1384207RC0200X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist