Healthcare Provider Details

I. General information

NPI: 1700983038
Provider Name (Legal Business Name): MORGAN K GRANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 RIVER PARK DR STE 125
PROVO UT
84604-6065
US

IV. Provider business mailing address

4292 W JOSHUA LN
CEDAR HILLS UT
84062-8056
US

V. Phone/Fax

Practice location:
  • Phone: 801-437-4500
  • Fax:
Mailing address:
  • Phone: 801-358-4663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number267959-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: