Provider Demographics
NPI:1093814162
Name:GRANT, MARIA B (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:B
Last Name:GRANT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-3003
Mailing Address - Country:US
Mailing Address - Phone:352-265-0301
Mailing Address - Fax:352-265-0627
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:BOX 100371
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-0301
Practice Address - Fax:352-265-0627
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2011-01-11
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Provider Licenses
StateLicense IDTaxonomies
FLME37351207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68389XMedicare PIN