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General NPI Number Information
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NPI Number | 1205144557
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Entity Type | Organization
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Legal Business Name | JAMES A GRANT MD INC
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Dates
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Enumeration Date | 09/21/2010
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Last Update Date | 09/29/2010
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Provider Practice Location Address
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Address Line | 4060 4TH AVE SUITE 410
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City | SAN DIEGO
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State | CA
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Zip | 92103-2116
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Country | US
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Telephone | 619-298-7109
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Fax | 619-298-8466
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Provider Business Mailing Address
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Address Line | 4060 4TH AVE SUITE 410
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City | SAN DIEGO
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State | CA
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Zip | 92103-2116
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Country | US
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Telephone | 619-298-7109
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Fax | 619-298-8466
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. JAMES A GRANT
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Credential | M.D
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Telephone | 619-298-7109
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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 | C26905
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License Number State | CA
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