MEDICARE: DENA 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
1	208000000X	Pediatrics Physician	ME62560	FL

General Provider Information

NPI Number	:	1528084506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENA G GRANT MD

Provider Business Mailing Address
First Line	:	406 REO ST
Second Line	:	220
City	:	TAMPA
State	:	FL
Zip	:	33609
Country	:	US
Telephone Number	:	813-636-2000
Fax Number	:	813-636-2050

Provider Business Practice Location Address
First Line	:	2550 W DR MARTIN LUTHER KING JR BLVD
Second Line	:	STE B HEALTHPOINT MEDICAL GROUP
City	:	TAMPA
State	:	FL
Zip	:	33607
Country	:	US
Telephone Number	:	813-876-4902
Fax Number	:	813-876-0472

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/08/2007

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