Healthcare Provider Details

I. General information

NPI: 1699870899
Provider Name (Legal Business Name): GRANT NEEDHAM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 N CASITAS HILL LOOP
WASHINGTON UT
84780-8922
US

IV. Provider business mailing address

1107 N CASITAS HILL LOOP
WASHINGTON UT
84780-8922
US

V. Phone/Fax

Practice location:
  • Phone: 435-632-7681
  • Fax: 435-250-3615
Mailing address:
  • Phone: 435-632-7681
  • Fax: 435-250-3615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number284995-1206
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number284995-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: