Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0201X | Internist - Allergy & Immunology | 49177 | CO |
Y | 207RA0201X | Internist - Allergy & Immunology | E1324 | TX |
NPI | 1700945342 |
---|---|
Provider Name | Prof. John Andrew Grant JR. |
First Address | Galveston, TX 77555-0561 |
Second Address | Galveston, TX 77555-0561 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 09/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
117162102 | (05) | TX |
67226051 | (05) | CO |