Provider Demographics
NPI:1932302700
Name:GRIGNON, DANIEL THOMAS (LMP)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:THOMAS
Last Name:GRIGNON
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-1929
Mailing Address - Country:US
Mailing Address - Phone:360-299-2543
Mailing Address - Fax:
Practice Address - Street 1:1015 6TH ST
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-1795
Practice Address - Country:US
Practice Address - Phone:360-299-2543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009923174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0179936OtherL&I PROVIDER ACCOUNT #