Provider Demographics
NPI:1992862296
Name:GRANT, PETER ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ALAN
Last Name:GRANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8143
Mailing Address - Country:US
Mailing Address - Phone:541-772-3200
Mailing Address - Fax:541-772-1048
Practice Address - Street 1:473 MURPHY RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8143
Practice Address - Country:US
Practice Address - Phone:541-772-3200
Practice Address - Fax:541-772-1048
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14454208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR124271Medicaid
OR124271Medicaid