Individual
BRUCE A GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 SAINT CHARLES AVE, NEW ORLEANS, LA 70170-1000
(504) 754-6950
(504) 524-7979
Mailing address
201 SAINT CHARLES AVE, NEW ORLEANS, LA 70170-1000
(504) 754-6950
(504) 524-7979
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2203783802
—
LA
Enumeration date
06/18/2018
Last updated
06/18/2018
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