MEDICARE: DR. GREGORY A. GRANT D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	E-4531	CA

General Provider Information

NPI Number	:	1154324812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY A. GRANT D.P.M.

Provider Business Mailing Address
First Line	:	1101 MADISON ST
Second Line	:	SUITE 301
City	:	SEATTLE
State	:	WA
Zip	:	98104-1306
Country	:	US
Telephone Number	:	206-505-1101
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 MADISON ST
Second Line	:	SUITE 301
City	:	SEATTLE
State	:	WA
Zip	:	98104-1306
Country	:	US
Telephone Number	:	206-505-1101
Fax Number	:

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	11/06/2021

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