Provider Demographics
NPI:1427169994
Name:GRANT, ROBBIE (DO)
Entity type:Individual
Prefix:DR
First Name:ROBBIE
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89446-0417
Mailing Address - Country:US
Mailing Address - Phone:775-623-6622
Mailing Address - Fax:775-623-0979
Practice Address - Street 1:395 W MINOR ST
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-3863
Practice Address - Country:US
Practice Address - Phone:775-623-6622
Practice Address - Fax:775-623-0979
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV102113OtherPTAN
NV002007007Medicaid
NVV102113OtherPTAN
NVE76151Medicare UPIN