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NPI Code Detail

MEDICARE: DAVID G GRANT MD

MEDICARE: DAVID G 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
1207Y00000XOtolaryngology PhysicianMFC1664FL
2207Y00000XOtolaryngology PhysicianE-11782AR

Other Identifiers

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

General Provider Information

NPI Number : 1174839864
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID G GRANT MD
Provider Business Mailing Address
First Line : 7003 CHAD COLLEY BLVD
Second Line :
City : BARLING
State : AR
Zip : 72923-3000
Country : US
Telephone Number : 479-431-3500
Fax Number :
Provider Business Practice Location Address
First Line : 7003 CHAD COLLEY BLVD
Second Line :
City : BARLING
State : AR
Zip : 72923-3000
Country : US
Telephone Number : 479-431-3500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2010
Last Update Date : 02/05/2019

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Directions to “ DAVID G GRANT MD” Practice Location

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