Individual
GRANT LEE MCBRIDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4120 SOUTHPORT TRACE DR, INDIANAPOLIS, IN 46237-2888
(317) 784-5071
Mailing address
4120 SOUTHPORT TRACE DR, INDIANAPOLIS, IN 46237-2888
(317) 784-5071
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01064365A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000605952
ANTHEM PTAN
IN
Enumeration date
07/02/2008
Last updated
12/05/2024
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