Individual
GRANT LIGHTFOOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 SW RAMSEY AVE, GRANTS PASS, OR 97527
(541) 472-7000
Mailing address
2620 E BARNETT RD, MEDFORD, OR 97504-8344
(313) 693-3363
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD190290
OR
390200000X
Student in an Organized Health Care Education/Training Program
4301110711
MI
Other
Enumeration date
07/22/2016
Last updated
07/08/2019
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