Organization
TIDEWATER FOOT & ANKLE CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM P. GRANT DPM (OWNER)
(757) 497-7575
Entity
Organization
Contact information
Practice address
760 INDEPENDENCE BLVD, VIRGINIA BEACH, VA 23455-6206
(757) 497-7575
Mailing address
PO BOX 55350, VIRGINIA BEACH, VA 23471-9350
(757) 497-7575
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
480000051
MEDICARE ID
VA
05
—
9301658
—
VA
Enumeration date
12/05/2006
Last updated
05/13/2009
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