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Individual
GRANT PRINCE
Active
Individual
GRANT PRINCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME126614
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017422900
—
FL
01
—
ME126614
MEDICAL LICENSE
FL
Enumeration date
03/23/2013
Last updated
11/16/2016
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