MEDICARE: DR. MELISSA ANN 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	207V00000X	Obstetrics & Gynecology Physician	MD61239189	WA
2	207V00000X	Obstetrics & Gynecology Physician	24900	NE
3	208D00000X	General Practice Physician	24900	NE
4	208M00000X	Hospitalist Physician	MD61239189	WA

General Provider Information

NPI Number	:	1629240882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA ANN GRANT MD

Provider Business Mailing Address
First Line	:	9040 JACKSON AVE ATTN: OB-GYN DEPARTMENT
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98431-0001
Country	:	US
Telephone Number	:	253-968-4621
Fax Number	:	253-968-5508

Provider Business Practice Location Address
First Line	:	9040 JACKSON AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98431-9098
Country	:	US
Telephone Number	:	253-968-4621
Fax Number	:	253-968-5508

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

Provider Enumeration Date	:	03/27/2008
Last Update Date	:	03/14/2022

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