Individual
ROY N GRANTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4221 S WESTERN AVE, 2010, OKLAHOMA CITY, OK 73109-3447
(405) 231-0540
(405) 644-5309
Mailing address
3545 NW 58TH ST, 450, OKLAHOMA CITY, OK 73112-4726
(405) 951-4360
(866) 857-2543
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
16465
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060052653
RAILROAD MEDICARE
—
05
—
100122170A
—
OK
01
—
125309100
DOL
OK
01
—
5765290
AETNA
OK
Enumeration date
09/19/2005
Last updated
12/04/2014
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