Individual
LISA C GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1615 E 12TH ST, SUITE 100, THE DALLES, OR 97058-3278
(541) 296-1100
(541) 236-0606
Mailing address
1615 E 12TH ST, SUITE 100, THE DALLES, OR 97058-3278
(541) 296-1100
(541) 236-0606
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MD24969
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
233198
—
OR
05
—
8402315
—
WA
Enumeration date
08/08/2006
Last updated
12/05/2016
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