Provider Demographics
NPI:1073671442
Name:CHRISTIAN, GRANT L (MD)
Entity Type:Individual
Prefix:MR
First Name:GRANT
Middle Name:L
Last Name:CHRISTIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MEDICAL DRIVE
Mailing Address - Street 2:SUITE 118
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010
Mailing Address - Country:US
Mailing Address - Phone:801-292-1422
Mailing Address - Fax:801-296-0436
Practice Address - Street 1:425 MEDICAL DRIVE
Practice Address - Street 2:SUITE 118
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010
Practice Address - Country:US
Practice Address - Phone:801-292-1422
Practice Address - Fax:801-296-0436
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT149797-8905207RC0000X
UT149797-1205208M00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107005467101OtherIHC
UTOMXAFO2632OtherALTIUS
UTOMXAFO2632OtherALTIUS
D07283Medicare UPIN