Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | BP10041558 | TX |
N | 208600000X | Surgeon | BP10041558 | TX |
Y | 208800000X | Urologist | Q8493 | TX |
NPI | 1013203645 |
---|---|
Provider Name | Dr. Jordan Richey Grant |
First Address | Temple, TX 76508-0001 |
Second Address | Temple, TX 76508-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2011 |
Last Update Date | 19/10/2018 |