Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 04-25791 | KS |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 111304 | MO |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 55171-020 | WI |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MD-13073 | HI |
NPI | 1174507214 |
---|---|
Provider Name | Dr. Pamela Jo Grant |
First Address | Topeka, KS 66604-1301 |
Second Address | Topeka, KS 66604-1301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 04/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
068002417 | MEDICARE PTAN (01) | KS |
100179790B | (05) | KS |
F62922 | (02) |