MEDICARE: SHAWN D GRANT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085B0100X	Body Imaging Physician	38822	KY
2	2085R0202X	Diagnostic Radiology Physician	38822	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043214497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN D GRANT MD

Provider Business Mailing Address
First Line	:	PO BOX 52750
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37950-2750
Country	:	US
Telephone Number	:	865-766-8897
Fax Number	:	865-766-8874

Provider Business Practice Location Address
First Line	:	1120 S UTICA AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-4012
Country	:	US
Telephone Number	:	918-579-7720
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	01/30/2013

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Directions to “ SHAWN D GRANT MD” Practice Location

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