Active NPI
Judy M Grisard, MD
- Surgery Physician
- Woodbury, MN
National Provider Identifier
1457301905
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 34598
- Practice address
- 8675 Valley Creek Rd
Woodbury, MN 55125-2337 - Phone
- (651) 241-3000
- NPI assigned
- May 12, 2006
- Last updated
- Oct 20, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 27215 | WI | |
| Surgery Physician | 208600000X | 03606305 | IL | |
| Surgery Physician | 208600000X | 34598 | MN | Primary |
Addresses
Primary practice location
8675 Valley Creek Rd
Woodbury, MN 55125-2337
Mailing address
2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-5000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03606305 | IL | MD | Surgery Physician |
| 27215 | WI | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319068800000",
"number": "1457301905",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2925 CHICAGO AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554071321",
"telephone_number": "612-262-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8675 VALLEY CREEK RD",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551252337",
"telephone_number": "651-241-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRISARD",
"first_name": "JUDY",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-12",
"last_updated": "2011-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WI",
"license": "27215",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "IL",
"license": "03606305",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MN",
"license": "34598",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, MN
- Garrett R Griffin, MD
- Madeleine Elizabeth Griffin, CCC-SLP
- Velma Ann Griggs, RN CNP
- Jonathan C Grimes, MD
- Shianne R Grindland, MA, LMFT
- Christine M Grismer, OTR/L
- Vanessa Groninger, RN
- Group Health, Inc. (HealthPartners Woodbury Dental Clinic)
- Group Health, Inc. (Cosmetic and Plastic Surgeons)
- Group Health, Inc. (HealthPartners Woodbury Clinic)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.