Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | A81040 | CA |
NPI | 1003895137 |
---|---|
Provider Name | Dr. Shannon K. Grant |
First Address | Bakersfield, CA 93390-0577 |
Second Address | Bakersfield, CA 93311-9781 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 10/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I06739 | (02) | CA |