Healthcare Provider Details

I. General information

NPI: 1518089986
Provider Name (Legal Business Name): BRIAN L. GRANT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 04/21/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 7TH AVE FL 21
SEATTLE WA
98101-1397
US

IV. Provider business mailing address

1158 17TH AVE E
SEATTLE WA
98112-3315
US

V. Phone/Fax

Practice location:
  • Phone: 206-447-3449
  • Fax: 206-812-6405
Mailing address:
  • Phone: 206-447-3449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00017737
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberMD00017737
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: