Provider Demographics
NPI:1417164963
Name:HAVEN, GRANT G (MD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:G
Last Name:HAVEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 WESTLAKE AVE N STE 901
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-3529
Mailing Address - Country:US
Mailing Address - Phone:206-264-8887
Mailing Address - Fax:206-264-8887
Practice Address - Street 1:1200 WESTLAKE AVE N STE 901
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3529
Practice Address - Country:US
Practice Address - Phone:206-264-8887
Practice Address - Fax:206-264-8887
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000290102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF75786Medicare UPIN