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NPI Code Detail

MEDICARE: DOUGLAS GRANT MD

MEDICARE: DOUGLAS 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
1208VP0000XPain Medicine PhysicianA78859CA

General Provider Information

NPI Number : 1922002542
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS GRANT MD
Provider Business Mailing Address
First Line : 450 N WIGET LN
Second Line :
City : WALNUT CREEK
State : CA
Zip : 94598-2408
Country : US
Telephone Number : 925-691-9806
Fax Number : 925-691-9807
Provider Business Practice Location Address
First Line : 450 N WIGET LN
Second Line :
City : WALNUT CREEK
State : CA
Zip : 94598-2408
Country : US
Telephone Number : 925-691-9806
Fax Number : 925-691-9807
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 10/22/2009

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Directions to “ DOUGLAS GRANT MD” Practice Location

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