Healthcare Provider Details

I. General information

NPI: 1891762332
Provider Name (Legal Business Name): GRANT JAMES LINNELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE FAHC RADIOLOGY
BURLINGTON VT
05401
US

IV. Provider business mailing address

6900 E CAMELBACK RD STE 700
SCOTTSDALE AZ
85251-2400
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-3593
  • Fax: 802-847-4822
Mailing address:
  • Phone: 480-306-6949
  • Fax: 602-302-5706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number320000530
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOS020989
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: