Healthcare Provider Details

I. General information

NPI: 1437366069
Provider Name (Legal Business Name): GRANT NEIL MEDEFIND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 W EL PORTAL DR
MERCED CA
95348-2853
US

IV. Provider business mailing address

PO BOX 3768
MERCED CA
95344-3768
US

V. Phone/Fax

Practice location:
  • Phone: 209-723-3704
  • Fax: 209-723-0272
Mailing address:
  • Phone: 209-725-7149
  • Fax: 209-726-0134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA97579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: