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Individual

JEFFREY S GRANT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
608 E COMANCHE ST, FARMINGTON, NM 87401-6815
(505) 325-0072
(505) 327-1739
Mailing address
PO BOX 677, FARMINGTON, NM 87499-0677
(505) 325-0072
(505) 327-1739

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
99216
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
99216
STATE LICENSE NUMBER
NM
Enumeration date
02/28/2007
Last updated
09/12/2012
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