Individual
DR. MATTHEW J GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2311 KALISTE SALOOM RD, LAFAYETTE, LA 70508-6807
(337) 231-5775
Mailing address
PO BOX 53134, LAFAYETTE, LA 70505-3134
(337) 261-5151
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
204686
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1216844
—
LA
Enumeration date
05/09/2007
Last updated
06/18/2013
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