Provider Demographics
NPI:1194717843
Name:GRANT, PAUL J (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:GRANT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1390 S POTOMAC ST
Mailing Address - Street 2:SUITE 124
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-6165
Mailing Address - Country:US
Mailing Address - Phone:303-368-8611
Mailing Address - Fax:303-368-9791
Practice Address - Street 1:1390 S POTOMAC ST
Practice Address - Street 2:SUITE 124
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-6165
Practice Address - Country:US
Practice Address - Phone:303-368-8611
Practice Address - Fax:303-368-9791
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2012-09-25
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Provider Licenses
StateLicense IDTaxonomies
CO17485207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01174853Medicare ID - Type Unspecified
CO446598Medicare ID - Type Unspecified
COD23285Medicare UPIN