Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | R2H91 | MO |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | R2H91 | MO |
NPI | 1144299413 |
---|---|
Provider Name | Dr. William Mark Grant |
First Address | Columbia, MO 65201-7166 |
Second Address | Columbia, MO 65201-7166 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 16/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
206649113 | (05) | MO |
E87098 | (02) | MO |