Organization
THE GRANT CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARC GRANT DO (PRESIDENT)
(602) 327-0184
Entity
Organization
Contact information
Practice address
14640 N TATUM BLVD STE 7, PHOENIX, AZ 85032-4824
(602) 327-0184
(602) 358-8063
Mailing address
PO BOX 45379, PHOENIX, AZ 85064-5379
(602) 327-0184
(602) 358-8063
Taxonomy
Speciality
Code
Description
License number
State
207LA0401X
Addiction Medicine (Anesthesiology) Physician
Primary
1609
AZ
Other
Enumeration date
11/17/2009
Last updated
11/17/2009
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