Individual
GRANT WESLEY HARRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11515 TOEPPERWEIN RD STE 203, LIVE OAK, TX 78233-3166
(210) 912-9507
Mailing address
20039 OAK CAVE, SAN ANTONIO, TX 78259-1817
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
U3229
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/20/2020
Last updated
07/06/2023
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