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General NPI Number Information
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NPI Number | 1043214497
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Entity Type | Individual
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Provider Name | SHAWN D GRANT MD
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Gender | Male
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 01/30/2013
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Provider Practice Location Address
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Address Line | 1120 S UTICA AVE
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City | TULSA
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State | OK
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Zip | 74104-4012
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Country | US
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Telephone | 918-579-7720
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 52750
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City | KNOXVILLE
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State | TN
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Zip | 37950-2750
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Country | US
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Telephone | 865-766-8897
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Fax | 865-766-8874
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | 38822
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 38822
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License Number State | KY
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