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General NPI Number Information
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NPI Number | 1548584105
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Entity Type | Organization
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Legal Business Name | CAROL GRANT MD LLC
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 10743 NARCOOSSEE RD
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City | ORLANDO
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State | FL
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Zip | 32832-6944
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Country | US
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Telephone | 407-592-1550
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Fax | 407-704-3323
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Provider Business Mailing Address
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Address Line | 10743 NARCOOSSEE RD
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City | ORLANDO
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State | FL
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Zip | 32832-6944
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Country | US
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Telephone | 407-592-1550
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Fax | 407-704-3323
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Authorized Official
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Title or Position | OWNER
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Name | CAROL R GRANT
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Credential | MD
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Telephone | 407-592-1550
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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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