Provider Demographics
NPI:1174507214
Name:GRANT, PAMELA JO (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JO
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 1:830 SW LANE ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-2487
Mailing Address - Country:US
Mailing Address - Phone:785-354-5952
Mailing Address - Fax:
Practice Address - Street 1:830 SW LANE ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2487
Practice Address - Country:US
Practice Address - Phone:785-354-5952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111304207VM0101X
KS04-25791207VM0101X, 207VM0101X
HIMD-13073207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100179790BMedicaid
KS068002417OtherMEDICARE PTAN
F62922Medicare UPIN