Individual
PAUL A GRANT JR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1612 S HENDERSON BLVD, KILGORE, TX 75662-3518
(903) 984-3505
Mailing address
PO BOX 8549, FORT WORTH, TX 76124-0549
(817) 451-4208
(817) 496-5151
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
J8559
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0027MP
BLUE CROSS BLUE SHIELD
TX
05
—
156199502
—
TX
Enumeration date
05/28/2006
Last updated
05/20/2013
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