# ROY N GRANTHAM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1568457265
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | 16465 | OK | Yes |

## Other

- **Enumeration date:** 09/19/2005
- **Last updated:** 12/04/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 060052653 | RAILROAD MEDICARE | — |
| 05 | — | 100122170A | — | OK |
| 01 | — | 125309100 | DOL | OK |
| 01 | — | 5765290 | AETNA | OK |