Provider Demographics
NPI:1578050266
Name:GRIGG, WILLIAM SPENCER (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SPENCER
Last Name:GRIGG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:400 W. 16TH STREET
Mailing Address - Street 2:GRADUATE MEDICAL EDUCATION DEPARTMENT
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003
Mailing Address - Country:US
Mailing Address - Phone:719-584-4000
Mailing Address - Fax:719-595-7589
Practice Address - Street 1:311 W 14TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2705
Practice Address - Country:US
Practice Address - Phone:719-595-7585
Practice Address - Fax:719-595-7589
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL.0007279207R00000X, 390200000X
CODR.0062850208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program