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Individual

DR. WILLIAM MARK GRANT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1705 E BROADWAY, SUITE 300, COLUMBIA, MO 65201-7166
(573) 817-0810
(573) 817-1790
Mailing address
1705 E BROADWAY, SUITE 300, COLUMBIA, MO 65201-7166
(573) 817-0810
(573) 817-1790

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
R2H91
MO
207VM0101X
Maternal & Fetal Medicine Physician
Primary
R2H91
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
206649113
MO
Enumeration date
03/17/2006
Last updated
07/16/2008
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