Provider Demographics
NPI:1790897908
Name:GRANT, ROBERT R (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:GRANT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5514 CORPORATE DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-7752
Mailing Address - Country:US
Mailing Address - Phone:816-271-1265
Mailing Address - Fax:816-279-7794
Practice Address - Street 1:5514 CORPORATE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-7752
Practice Address - Country:US
Practice Address - Phone:816-271-1265
Practice Address - Fax:816-279-7794
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2017-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2003014163207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100644360BMedicaid
MOP00238408OtherRR MEDICARE
MO208321802Medicaid
KS103185Medicare UPIN
MO701C562Medicare PIN
KS100644360BMedicaid
MOMA4170039Medicare UPIN