Provider Demographics
NPI:1285602078
Name:GRAN, BERNARD (MD)
Entity type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:
Last Name:GRAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9960 NW 116TH WAY
Mailing Address - Street 2:SUITE 13
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1167
Mailing Address - Country:US
Mailing Address - Phone:786-924-1631
Mailing Address - Fax:786-924-1311
Practice Address - Street 1:9055 SW 87TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2306
Practice Address - Country:US
Practice Address - Phone:305-596-2080
Practice Address - Fax:305-351-7905
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00306392084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAG1185025OtherDEA
FLD63591Medicare UPIN
FLAG1185025OtherDEA