Provider Demographics
NPI:1093994469
Name:ROBICHEAUX, GRANT WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:WILLIAM
Last Name:ROBICHEAUX
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 1:2617 E CHAPMAN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3226
Mailing Address - Country:US
Mailing Address - Phone:714-639-3780
Mailing Address - Fax:714-639-9203
Practice Address - Street 1:2617 E CHAPMAN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3226
Practice Address - Country:US
Practice Address - Phone:714-639-3780
Practice Address - Fax:714-639-9203
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1847955207X00000X
CAA108059390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program