Individual
GRANT NEEDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1107 N CASITAS HILL LOOP, WASHINGTON, UT 84780-8922
(435) 632-7681
(435) 250-3615
Mailing address
1107 N CASITAS HILL LOOP, WASHINGTON, UT 84780-8922
(435) 632-7681
(435) 250-3615
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
284995-1206
UT
363AM0700X
Medical Physician Assistant
284995-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
716871001
AHCCS
AZ
Enumeration date
09/13/2006
Last updated
07/07/2026
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