MEDICARE: CONOR GRANT

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	207RI0200X	Infectious Disease Physician	2025029612	MO

General Provider Information

NPI Number	:	1750265039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONOR GRANT

Provider Business Mailing Address
First Line	:	4523 CLAYTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4523 CLAYTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1501
Country	:	US
Telephone Number	:	314-454-8293
Fax Number	:

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

Provider Enumeration Date	:	08/01/2025
Last Update Date	:	08/01/2025

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Directions to “ CONOR GRANT ” Practice Location

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