Provider Demographics
NPI:1164587259
Name:GRANT, DOMINIQUE K (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:K
Last Name:GRANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W 8TH AVE
Mailing Address - Street 2:SUITE 6060
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2302
Mailing Address - Country:US
Mailing Address - Phone:509-838-4211
Mailing Address - Fax:509-838-6432
Practice Address - Street 1:105 W 8TH AVE
Practice Address - Street 2:SUITE 6060
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2302
Practice Address - Country:US
Practice Address - Phone:509-838-4211
Practice Address - Fax:509-838-6432
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6628207V00000X
WAMD 60141997207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology