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General NPI Number Information
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NPI Number | 1174151369
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Entity Type | Individual
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Provider Name | GRANT BREELAND MD
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Gender | Male
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Dates
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Enumeration Date | 04/01/2020
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 815 S PINE ST
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City | VIVIAN
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State | LA
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Zip | 71082-3353
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Country | US
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Telephone | 318-375-3235
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Fax | 706-596-6704
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Provider Business Mailing Address
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Address Line | PO BOX 3488 DEPT 05-048
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City | TUPELO
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State | MS
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Zip | 38803-3488
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Country | US
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Telephone | 866-264-3435
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Fax | 706-596-6704
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | U6923
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | U6923
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License Number State | TX
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