Provider Demographics
NPI:1366545253
Name:HOPE, GRANT J (DO)
Entity type:Individual
Prefix:MR
First Name:GRANT
Middle Name:J
Last Name:HOPE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:GRANT
Other - Middle Name:J
Other - Last Name:HOPE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:140 HILL STREET
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820
Mailing Address - Country:US
Mailing Address - Phone:419-562-2676
Mailing Address - Fax:419-562-7396
Practice Address - Street 1:140 HILL STREET
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820
Practice Address - Country:US
Practice Address - Phone:419-562-2676
Practice Address - Fax:419-562-7396
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004041207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34155524500OtherANTHEM
OH0653252Medicaid
OHH00599671Medicare ID - Type Unspecified
OH0653252Medicaid