Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Andre D Grisham, MD

Individual provider Surgery Physician · NPI 1629042122

Andre D Grisham, MD is a General Surgery in Tigard, Oregon. Graduated from University of Kentucky College of Medicine in 1999, 27 years ago. Practices with Providence Health and Services Oregon, a 1,426-clinician group and accepts Medicare assignment. Licensed in Oregon, South Carolina and Tennessee.

Years since qualifying
27
Trained at
University of Kentucky College of Medicine
Licensed in
OR, SC, TN
In the registry since
2006
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

9250 SW Hall Blvd
Tigard, OR 97223-6721
Phone: (503) 221-0161
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgery Physician (primary) Taxonomy 208600000X · Licence MD151172 (OR)
Surgery Physician Taxonomy 208600000X · Licence 29462 (SC)
Surgery Physician Taxonomy 208600000X · Licence 38146 (TN)

Record details

NPI number1629042122
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedFebruary 14, 2006
Last updated in NPPESJuly 21, 2022
Certification dateNovember 6, 2020
Mailing address800 Sw 13th Ave, Portland, OR 97205-1902

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyGENERAL SURGERY
Medical schoolUNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE
Graduated 1999 (27 years in practice)
Group practice Providence Health And Services Oregon — 1426 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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