Provider Demographics
NPI:1700027794
Name:GRIESHABER, DOMENICK CARRA (MD)
Entity Type:Individual
Prefix:
First Name:DOMENICK
Middle Name:CARRA
Last Name:GRIESHABER
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 1:3800 HOUMA BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4192
Mailing Address - Country:US
Mailing Address - Phone:504-249-7576
Mailing Address - Fax:504-454-2763
Practice Address - Street 1:3800 HOUMA BLVD STE 310
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4192
Practice Address - Country:US
Practice Address - Phone:504-249-7576
Practice Address - Fax:504-454-2763
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.203888207L00000X, 207LP2900X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07785768Medicaid
LA1941603Medicaid
LA1941603Medicaid
LA354940YH3UMedicare PIN