Healthcare Provider Details

I. General information

NPI: 1548277726
Provider Name (Legal Business Name): WILLIAM NELSON GRANT III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9375 EMERALD COAST PKWY W STE 6
MIRAMAR BEACH FL
32550-7275
US

IV. Provider business mailing address

1006 EMERALD BAY DR
DESTIN FL
32541-3779
US

V. Phone/Fax

Practice location:
  • Phone: 850-533-0166
  • Fax:
Mailing address:
  • Phone: 850-533-0166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP7451
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME123998
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: