Provider Demographics
NPI:1780899922
Name:GRENFELL, RAYMOND FREDERIC III (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:FREDERIC
Last Name:GRENFELL
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:971 LAKELAND DR
Mailing Address - Street 2:ST. DOMINIC WEST TOWER SUITE 450
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4643
Mailing Address - Country:US
Mailing Address - Phone:601-948-5158
Mailing Address - Fax:601-949-6058
Practice Address - Street 1:971 LAKELAND DR
Practice Address - Street 2:ST. DOMINIC WEST TOWER SUITE 450
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4643
Practice Address - Country:US
Practice Address - Phone:601-948-5158
Practice Address - Fax:601-326-4265
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS21031207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1780902155OtherGROUP NPI NUMBER