Healthcare Provider Details

I. General information

NPI: 1548436496
Provider Name (Legal Business Name): DANIELLE DENISE GRANT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13917 W. HIGHWAY 71 A
AUSTIN TX
78738-3008
US

IV. Provider business mailing address

13917 W. HIGHWAY 71 A
AUSTIN TX
78738-3008
US

V. Phone/Fax

Practice location:
  • Phone: 512-610-7030
  • Fax: 512-610-7034
Mailing address:
  • Phone: 512-610-7030
  • Fax: 512-610-7034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM8687
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: