Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 04-31027 | KS |
Y | 207T00000X | Neurosurgeon | 264268 | NY |
N | 2086S0120X | Pediatric Surgery | 036-084798 | IL |
NPI | 1093701278 |
---|---|
Provider Name | Mr. John Andrew Grant |
First Address | Rockville Centre, NY 11570 |
Second Address | Rockville Centre, NY 11570 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 07/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100149820D | (05) | KS |
208392217 | (05) | MO |
32553028 | BCBS KANSAS CITY (01) | MO |
513490 | FIRSTGUARD (01) | KS |
G20755 | (02) | IL |