MEDICARE: BRADLEY P GRANT MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1083894125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADLEY P GRANT MD PA

Provider Business Mailing Address
First Line	:	1480 S WICKHAM RD
Second Line	:
City	:	W MELBOURNE
State	:	FL
Zip	:	32904-2447
Country	:	US
Telephone Number	:	321-724-2188
Fax Number	:	321-724-2833

Provider Business Practice Location Address
First Line	:	1480 S WICKHAM RD
Second Line	:
City	:	W MELBOURNE
State	:	FL
Zip	:	32904-2447
Country	:	US
Telephone Number	:	321-724-2188
Fax Number	:	321-724-2833

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRADLEY P GRANT
Credential	:	MD
Telephone Number	:	321-724-2188

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	06/26/2008

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Directions to “BRADLEY P GRANT MD PA ” Practice Location

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