Provider Demographics
NPI:1386494169
Name:GRANT, JORDAN DAVID (MBBS)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:DAVID
Last Name:GRANT
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 NORTH UNION STREET
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760
Mailing Address - Country:US
Mailing Address - Phone:716-375-7500
Mailing Address - Fax:716-701-1557
Practice Address - Street 1:850 HOPKINS ROAD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-688-9641
Practice Address - Fax:716-829-2447
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program