Individual
GREGORY GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3214 KETHLEY RD, SHAWNEE, OK 74804-9625
(405) 273-5801
(405) 878-3814
Mailing address
PO BOX 849, SHAWNEE, OK 74802-0849
(405) 273-5801
(405) 878-3814
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25087
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200124950A
—
OK
Enumeration date
02/12/2007
Last updated
08/30/2012
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