Provider Demographics
NPI:1982623252
Name:GRAND, HARRELL A (MD)
Entity type:Individual
Prefix:
First Name:HARRELL
Middle Name:A
Last Name:GRAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3801 GASTON AVE
Mailing Address - Street 2:315
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1541
Mailing Address - Country:US
Mailing Address - Phone:214-824-2121
Mailing Address - Fax:214-824-2406
Practice Address - Street 1:3801 GASTON AVE
Practice Address - Street 2:315
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1541
Practice Address - Country:US
Practice Address - Phone:214-824-2121
Practice Address - Fax:214-824-2406
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2013-04-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG5914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC16259Medicare UPIN
TX8K1950Medicare ID - Type UnspecifiedMEDICARE