Individual
DR. JONATHAN R GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 S 13TH ST, MOUNT VERNON, WA 98274-4105
(360) 336-2178
(360) 336-1674
Mailing address
111 S 13TH ST, MOUNT VERNON, WA 98274-4105
(360) 336-2178
(360) 336-1674
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
242010
MA
207Y00000X
Otolaryngology Physician
47898-020
WI
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
MD60187241
WA
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
MD60187241
WA
208600000X
Surgery Physician
MD60187241
WA
2086S0122X
Plastic and Reconstructive Surgery Physician
MD60187241
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0271141
LABOR AND INDUSTRIES
WA
05
—
2009841
—
WA
01
—
P00700778
RAILROAD MEDICARE
—
Enumeration date
01/02/2007
Last updated
03/15/2012
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