Provider Demographics
NPI:1972922797
Name:GRANT, CAMPBELL (MD)
Entity type:Individual
Prefix:DR
First Name:CAMPBELL
Middle Name:
Last Name:GRANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 ROSE STREET MS 235
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0298
Mailing Address - Country:US
Mailing Address - Phone:859-323-6679
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE STE B200
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-3201
Practice Address - Country:US
Practice Address - Phone:859-257-3533
Practice Address - Fax:859-257-6024
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY549772088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program