Provider Demographics
NPI:1275100356
Name:GRANT, BRADLEY JAY (MD, JD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:JAY
Last Name:GRANT
Suffix:
Gender:M
Credentials:MD, JD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 650859
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0859
Mailing Address - Country:US
Mailing Address - Phone:409-772-2222
Mailing Address - Fax:
Practice Address - Street 1:301 UNIVERSITY BLVD DEPT OF
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-5302
Practice Address - Country:US
Practice Address - Phone:409-772-2870
Practice Address - Fax:409-747-2400
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP10074431OtherTEXAS PHYSICIAN IN TRAINING PERMIT
72566OtherUNITED STATES PATENT AND TRADEMARK OFFICE REGISTRATION NUMBER