Provider Demographics
NPI:1447440532
Name:GRIGORIAN, RUBEN ABRAMOVICH (MD)
Entity type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:ABRAMOVICH
Last Name:GRIGORIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-4414
Mailing Address - Country:US
Mailing Address - Phone:318-325-2610
Mailing Address - Fax:318-325-7715
Practice Address - Street 1:108 REGENCY PL
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-4452
Practice Address - Country:US
Practice Address - Phone:318-325-2610
Practice Address - Fax:318-325-7715
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201602207W00000X
MDD0069475207W00000X
ALMD31012207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE160888ZEG1Medicare PIN
MD160850ZEBKMedicare PIN