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General NPI Number Information
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NPI Number | 1932178720
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Entity Type | Individual
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Provider Name | LAURA L GRANT M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1705 E. BROADWAY SUITE 300
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City | COLUMBIA
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State | MO
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Zip | 65201-6863
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Country | US
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Telephone | 573-449-9355
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Fax | 573-441-9355
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Provider Business Mailing Address
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Address Line | 1705 E. BROADWAY, SUITE 300
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City | COLUMBIA
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State | MO
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Zip | 65201-5852
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Country | US
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Telephone | 573-449-9355
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Fax | 573-441-9355
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 106052
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License Number State | MO
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