Basic Information
| Provider Information | |||||||||
| NPI: | 1245310838 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRYSPEERDT | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | ANDRE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 236 | ||||||||
| Address2: | |||||||||
| City: | BATESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 470060236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129335441 | ||||||||
| FaxNumber: | 8129335446 | ||||||||
| Practice Location | |||||||||
| Address1: | 188 STATE RD 229 | ||||||||
| Address2: | |||||||||
| City: | BATESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129346381 | ||||||||
| FaxNumber: | 8129343632 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 03/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01043536 | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200050780A | 05 | IN | MEDICAID |