Healthcare Provider Details

I. General information

NPI: 1477082675
Provider Name (Legal Business Name): GRANT MCCHESNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-5302
US

IV. Provider business mailing address

301 UNIVERSITY BLVD
GALVESTON TX
77555-0165
US

V. Phone/Fax

Practice location:
  • Phone: 832-505-1200
  • Fax:
Mailing address:
  • Phone: 832-505-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberBP10060916
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: