Provider Demographics
NPI:1992724736
Name:GRANT, EDMUND G (MD)
Entity type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:G
Last Name:GRANT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:525-670-1883
Mailing Address - Fax:813-355-5101
Practice Address - Street 1:14014 N 46TH ST STE C
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4238
Practice Address - Country:US
Practice Address - Phone:813-971-8811
Practice Address - Fax:813-355-5054
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00373502084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30561OtherBCBS
FL068668900Medicaid