Provider Demographics
NPI:1891762332
Name:LINNELL, GRANT JAMES (DO)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:JAMES
Last Name:LINNELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6900 E CAMELBACK RD STE 700
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-2400
Mailing Address - Country:US
Mailing Address - Phone:480-306-6949
Mailing Address - Fax:602-302-5706
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:FAHC RADIOLOGY
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-847-3593
Practice Address - Fax:802-847-4822
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT3200005302085R0202X
PAOS0209892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02722329Medicaid
PA103897288Medicaid
VT1012212Medicaid
VT1012212Medicaid