Provider Demographics
NPI:1356481790
Name:BELNAP, GRANT B (MD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:B
Last Name:BELNAP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1032 S BRIDGEWAY PLACE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616
Mailing Address - Country:US
Mailing Address - Phone:208-246-0123
Mailing Address - Fax:208-246-0125
Practice Address - Street 1:1032 S BRIDGE WAY PL
Practice Address - Street 2:SUITE 100
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6099
Practice Address - Country:US
Practice Address - Phone:208-246-0123
Practice Address - Fax:208-246-0125
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2012-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM73572084A0401X, 2084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry