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General NPI Number Information
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NPI Number | 1427790823
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Entity Type | Individual
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Provider Name | ABIGAIL THERESA GRANT MD
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Gender | Female
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Dates
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Enumeration Date | 04/07/2022
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Last Update Date | 08/16/2025
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Provider Practice Location Address
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Address Line | 3930 S BROADWAY
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City | SAINT LOUIS
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State | MO
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Zip | 63118-4626
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Country | US
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Telephone | 314-814-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 3930 S BROADWAY
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City | SAINT LOUIS
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State | MO
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Zip | 63118-4626
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Country | US
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Telephone | 314-814-1700
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2025035234
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License Number State | MO
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