Individual
MR. LONNIE L GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2107 BOX BUTTE AVE, ALLIANCE, NE 69301-4415
(308) 762-7244
(308) 762-6657
Mailing address
2091 BOX BUTTE AVE, STE 500, ALLIANCE, NE 69301-4456
(308) 623-2139
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
762
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38772
BCBSNE
NE
05
—
506729276
—
NE
01
—
970016869
RR MEDICARE - BBGH
—
01
—
P00165962
RR MEDICARE - SFC
—
Enumeration date
12/06/2006
Last updated
03/12/2018
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