Provider Demographics
NPI:1669580171
Name:GRISWOLD, AMY A (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:A
Last Name:GRISWOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1180 8TH AVE W # 311
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-3810
Mailing Address - Country:US
Mailing Address - Phone:941-748-7246
Mailing Address - Fax:941-748-7244
Practice Address - Street 1:842 62ND ST CIR E
Practice Address - Street 2:#104
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208
Practice Address - Country:US
Practice Address - Phone:941-748-7246
Practice Address - Fax:941-748-7244
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67865207L00000X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG12621Medicare UPIN