Provider Demographics
NPI:1275829400
Name:ROWLAND, GRANT MARSHALL (MD)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:MARSHALL
Last Name:ROWLAND
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 1:3121 UNIVERSITY DR E STE 100
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3499
Mailing Address - Country:US
Mailing Address - Phone:979-776-0169
Mailing Address - Fax:979-776-1372
Practice Address - Street 1:3121 UNIVERSITY DR E STE 100
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3499
Practice Address - Country:US
Practice Address - Phone:979-776-0169
Practice Address - Fax:979-776-1372
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-07753207X00000X
KY49369207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX374266001Medicaid