Provider Demographics
NPI:1346304870
Name:GRANT, JEFFREY NATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:NATHAN
Last Name:GRANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8733 BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1842
Mailing Address - Country:US
Mailing Address - Phone:310-659-4511
Mailing Address - Fax:310-659-1520
Practice Address - Street 1:8733 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1842
Practice Address - Country:US
Practice Address - Phone:310-659-4511
Practice Address - Fax:310-659-1520
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2011-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA24260207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23880Medicare UPIN