Organization
GRANT CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARC GRANT D.O. (PRESIDENT)
(602) 327-0184
Entity
Organization
Contact information
Practice address
708 S COEUR D ALENE LN, SUITE D, PAYSON, AZ 85541-5662
(928) 468-1337
(928) 468-1339
Mailing address
708 S COEUR DALENE LANE, SUITE D, PAYSON, AZ 85541-5662
(928) 468-1337
(928) 468-1339
Taxonomy
Speciality
Code
Description
License number
State
207LA0401X
Addiction Medicine (Anesthesiology) Physician
1609
AZ
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
1609
AZ
Other
Enumeration date
09/23/2010
Last updated
06/06/2013
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