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General NPI Number Information
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NPI Number | 1285814566
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Entity Type | Organization
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Legal Business Name | JEFFREY M. GRAN, PSY.D., P.A.
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 1050 NE 125TH ST
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City | NORTH MIAMI
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State | FL
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Zip | 33161-5805
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Country | US
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Telephone | 954-558-2870
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Fax | 954-893-7829
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Provider Business Mailing Address
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Address Line | 420 SW 70TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33023-1019
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Country | US
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Telephone | 954-893-7829
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Fax | 954-893-7829
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY M. GRAN
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Credential | PSY.D.
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Telephone | 954-893-7829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PY 5683
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License Number State | FL
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