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General NPI Number Information
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NPI Number | 1205056421
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Entity Type | Individual
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Provider Name | GRANT R KOLAR M.D., PHD.
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Gender | Male
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 02/08/2010
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Provider Practice Location Address
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Address Line | 660 S. EUCLID, BOX 8118
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City | SAINT LOUIS
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State | MO
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Zip | 63108
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Country | US
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Telephone | 314-362-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 4151 OLIVE STREET
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City | SAINT LOUIS
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State | MO
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Zip | 63108
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Country | US
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Telephone | 314-533-4947
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Fax |
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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 | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 2006016382
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 2009001447
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License Number State | MO
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