# RICHARD L GRANT MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114000536
- **Authorized official:** RICHARD LOCKE GRANT MD (PRESIDENT)
- **Authorized official phone:** (309) 692-5550

## Contact information

- **Practice address:** 7309 N KNOXVILLE, PEORIA, IL 61614
- **Practice address phone:** (309) 692-5550
- **Practice address fax:** (309) 692-5553
- **Mailing address:** 709 TOWNES COURT, PEORIA, IL 61615-1381
- **Mailing address phone:** (309) 692-5550
- **Mailing address fax:** (309) 692-5553

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084F0202X | Forensic Psychiatry Physician | — | IL | Yes |

## Other

- **Enumeration date:** 10/21/2006
- **Last updated:** 08/22/2020