Provider Demographics
NPI:1356655781
Name:EYJOLFSON, GRANT WILLIAM (MD)
Entity Type:Individual
Prefix:MR
First Name:GRANT
Middle Name:WILLIAM
Last Name:EYJOLFSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:501 E. LINCOLN ST.
Mailing Address - Street 2:PO BOX 106
Mailing Address - City:HENDRICKS
Mailing Address - State:MN
Mailing Address - Zip Code:56136
Mailing Address - Country:US
Mailing Address - Phone:507-275-3121
Mailing Address - Fax:507-275-3194
Practice Address - Street 1:1000 SOUTH COLUMBIA ROAD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58206-6002
Practice Address - Country:US
Practice Address - Phone:701-780-5000
Practice Address - Fax:701-780-6860
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN56053207Q00000X
NDRL11611207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine