Provider Demographics
NPI:1245441898
Name:GRINNELL, ORTON F (CFA)
Entity type:Individual
Prefix:MR
First Name:ORTON
Middle Name:F
Last Name:GRINNELL
Suffix:
Gender:M
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 AUDUBON DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471
Mailing Address - Country:US
Mailing Address - Phone:985-845-1501
Mailing Address - Fax:985-845-1601
Practice Address - Street 1:230 AUDUBON DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471
Practice Address - Country:US
Practice Address - Phone:985-845-1501
Practice Address - Fax:985-845-1601
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSF01315246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF01315OtherN CERT OF FIRST ASSISTANT