Provider Demographics
NPI:1437405776
Name:CORI E. GRANTHAM, M.D., P.A.
Entity Type:Organization
Organization Name:CORI E. GRANTHAM, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORI
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GRANTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-691-7077
Mailing Address - Street 1:8220 WALNUT HILL LN
Mailing Address - Street 2:310
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4427
Mailing Address - Country:US
Mailing Address - Phone:214-691-7077
Mailing Address - Fax:214-692-8421
Practice Address - Street 1:8220 WALNUT HILL LN
Practice Address - Street 2:310
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4427
Practice Address - Country:US
Practice Address - Phone:214-691-7077
Practice Address - Fax:214-692-8421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2658174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty