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NPI Code Detail

MEDICARE: DR. GRANT HAMILTON BREAZEALE M.D.

MEDICARE: DR. GRANT HAMILTON BREAZEALE M.D.
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
1207R00000XInternal Medicine Physician43864KY
2207RP1001XPulmonary Disease Physician01079745AIN
3207RP1001XPulmonary Disease Physician43864KY

General Provider Information

NPI Number : 1922119122
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GRANT HAMILTON BREAZEALE M.D.
Provider Business Mailing Address
First Line : PO BOX 635283
Second Line :
City : CINCINNATI
State : OH
Zip : 45263-5283
Country : US
Telephone Number : 859-757-2927
Fax Number : 859-341-0203
Provider Business Practice Location Address
First Line : 651 CENTRE VIEW BOULEVARD
Second Line :
City : CRESTVIEW HILLS
State : KY
Zip : 41017-5423
Country : US
Telephone Number : 859-757-2927
Fax Number : 859-341-0203
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 06/27/2025

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