Individual
JEFFREY DANIEL GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
417 N 11TH ST, RICHMOND, VA 23298-5002
(804) 828-7069
(804) 828-4762
Mailing address
PO BOX 91734, RICHMOND, VA 23291-1734
(804) 358-6100
(804) 342-7619
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110001193
VA
Other
Enumeration date
10/17/2006
Last updated
01/14/2019
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