Individual
DR. JERRY H GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
104 EAST GROVE, GRANTMED, EL DORADO, AR 71730-3929
(870) 862-2285
(870) 862-2289
Mailing address
104 EAST GROVE, GRANTMED, EL DORADO, AR 71730-3929
(870) 862-2285
(870) 862-2289
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
EO952
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080128979
RAILROAD MEDICARE
AR
05
—
130237001
—
AR
Enumeration date
03/14/2006
Last updated
08/21/2019
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