Provider Demographics
NPI:1215909809
Name:GRIJALVA, STEVEN D (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:GRIJALVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STEVEN
Other - Middle Name:DIONISIO
Other - Last Name:GRIJALVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-952-2111
Mailing Address - Fax:423-282-1657
Practice Address - Street 1:410 N STATE OF FRANKLIN RD STE 140
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6972
Practice Address - Country:US
Practice Address - Phone:423-431-2460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA88491207X00000X
TN65127207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery