MEDICARE: ADAM GRANT D.O.

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	207Q00000X	Family Medicine Physician	274782	NY
2	207Q00000X	Family Medicine Physician	E-9902	AR

General Provider Information

NPI Number	:	1487074639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM GRANT D.O.

Provider Business Mailing Address
First Line	:	401 W CAPITOL AVE
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72201-3421
Country	:	US
Telephone Number	:	501-374-2626
Fax Number	:	501-374-2655

Provider Business Practice Location Address
First Line	:	401 W CAPITOL AVE
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72201-3421
Country	:	US
Telephone Number	:	501-374-2626
Fax Number	:	501-374-2655

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

Provider Enumeration Date	:	04/25/2014
Last Update Date	:	08/02/2016

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Directions to “ ADAM GRANT D.O.” Practice Location

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