Provider Demographics
NPI:1508823659
Name:GRANT, ROBERT (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GRANT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 UNIVERSITY BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2775
Mailing Address - Country:US
Mailing Address - Phone:561-323-6555
Mailing Address - Fax:561-323-6556
Practice Address - Street 1:500 UNIVERSITY BLVD STE 211
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2775
Practice Address - Country:US
Practice Address - Phone:561-323-6555
Practice Address - Fax:561-323-6556
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007437207RP1001X
FLOS4194207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2892103Medicaid
MI5630288Medicare ID - Type Unspecified
MI2892103Medicaid