Provider Demographics
NPI:1124253471
Name:HA GRAND PA
Entity type:Organization
Organization Name:HA GRAND PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARRELL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GRAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-824-2121
Mailing Address - Street 1:3801 GASTON AVE
Mailing Address - Street 2:315
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1541
Mailing Address - Country:US
Mailing Address - Phone:214-824-2121
Mailing Address - Fax:214-824-2406
Practice Address - Street 1:3801 GASTON AVE
Practice Address - Street 2:315
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1541
Practice Address - Country:US
Practice Address - Phone:214-824-2121
Practice Address - Fax:214-824-2406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5914207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty