Individual
GRANT MCLEOD VAN DER VOORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036173780
IL
208800000X
Urology Physician
Primary
18044
SD
390200000X
Student in an Organized Health Care Education/Training Program
TL.0007995
CO
Other
Enumeration date
03/26/2020
Last updated
08/07/2026
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