Individual
GRANT NEEDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1380 E MEDICAL CENTER DR STE 4100, ST GEORGE, UT 84790-2156
(435) 867-8719
(435) 867-5763
Mailing address
1055 N 500 W, ATTN CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
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
11/27/2023
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