Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 242010 | MA |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 47898-020 | WI |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MD60187241 | WA |
N | 208200000X | Surgeon | MD60187241 | WA |
N | 208600000X | Surgeon | MD60187241 | WA |
N | 2086S0122X | Plastic and Reconstructive Surgery | MD60187241 | WA |
NPI | 1912064577 |
---|---|
Provider Name | Dr. Jonathan R Grant |
First Address | Mount Vernon, WA 98274-4105 |
Second Address | Mount Vernon, WA 98274-4105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 15/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0271141 | LABOR AND INDUSTRIES (01) | WA |
2009841 | (05) | WA |
P00700778 | RAILROAD MEDICARE (01) |