NPI 1629042122

Andre D Grisham, MD

Practitioner Surgery Physician Tigard, OR

Practice location

Address: 9250 SW Hall Blvd, Tigard, OR 97223-6721
Phone: (503) 221-0161
Mailing address: 800 SW 13th Ave, Portland, OR 97205-1902

Registered specialties (3)

Surgery Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208600000X Licence MD151172 (OR)

Other Surgery providers in Oregon →

Surgery Physician

Allopathic & Osteopathic Physicians Taxonomy 208600000X Licence 29462 (SC)

Surgery Physician

Allopathic & Osteopathic Physicians Taxonomy 208600000X Licence 38146 (TN)

Registry record

NPI: 1629042122
Entity type: Individual
Sex (as registered): Male
NPI issued: 14 Feb 2006
Record last updated: 21 Jul 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.