Provider Demographics
NPI:1699711838
Name:GRANT, GREGORY M (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:M
Last Name:GRANT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5229 E DOUBLETREE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1645
Mailing Address - Country:US
Mailing Address - Phone:602-252-3829
Mailing Address - Fax:602-252-3846
Practice Address - Street 1:525 N 18TH ST
Practice Address - Street 2:SUITE 503
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-4102
Practice Address - Country:US
Practice Address - Phone:602-252-3829
Practice Address - Fax:602-252-3846
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ28675207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ710419Medicaid
AZ710419Medicaid
AZZ104493Medicare PIN