Provider Demographics
NPI:1487093969
Name:GRINAGE, EGBERT FITZSTEPHEN JR (MD)
Entity type:Individual
Prefix:DR
First Name:EGBERT
Middle Name:FITZSTEPHEN
Last Name:GRINAGE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1680 DIAGONAL ROAD
Mailing Address - Street 2:SANFORD WORTHINGTON CLINIC
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187
Mailing Address - Country:US
Mailing Address - Phone:507-372-3800
Mailing Address - Fax:507-372-3806
Practice Address - Street 1:1680 DIAGONAL RD
Practice Address - Street 2:SANFORD WORTHINGTON CLINIC
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-1008
Practice Address - Country:US
Practice Address - Phone:507-372-3800
Practice Address - Fax:507-372-3806
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2022-03-25
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Provider Licenses
StateLicense IDTaxonomies
MN61589261QP2300X
390200000X
ORMD192028208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program