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General NPI Number Information
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NPI Number | 1861466278
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Entity Type | Individual
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Provider Name | GREGORY ERSKINE GRANT M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 10/18/2021
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Provider Practice Location Address
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Address Line | BAYNE-JONES ARMY COMMUNITY HOSPITAL 1585 THIRD ST
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City | FORT POLK
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State | LA
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Zip | 71459-5102
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Country | US
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Telephone | 337-531-2063
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Fax |
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Provider Business Mailing Address
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Address Line | 24 HIGHLAND PL
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City | BROOKLYN
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State | NY
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Zip | 11208-1219
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Country | US
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Telephone | 718-791-8653
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Fax | 347-402-2783
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 233767
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License Number State | NY
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