Provider Demographics
NPI:1013069541
Name:J KIRKLAND GRANT, M.D. PA
Entity Type:Organization
Organization Name:J KIRKLAND GRANT, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:J KIRKLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-686-8200
Mailing Address - Street 1:182 S COLLINS RD STE 800
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-4652
Mailing Address - Country:US
Mailing Address - Phone:972-686-8200
Mailing Address - Fax:972-686-7711
Practice Address - Street 1:182 S COLLINS RD STE 800
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-4652
Practice Address - Country:US
Practice Address - Phone:972-686-8200
Practice Address - Fax:972-686-7711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4018207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114499002Medicaid
TX4272341OtherAETNA
TX10018543Medicaid
TX084138901Medicaid
TX3287Medicaid
TX81W310OtherBC & BS
TX114499002Medicaid
TX4272341OtherAETNA
TX81W310OtherBC & BS
TX80N274Medicare ID - Type UnspecifiedPA'S MEDICARE #
TX00N32FMedicare ID - Type UnspecifiedGROUP #