Provider Demographics
NPI:1457334708
Name:GRANT, LEE B JR (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:B
Last Name:GRANT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2500 E PROSPECT
Mailing Address - Street 2:ORTHOPAEDIC CENTER OF THE ROCKIES
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-9718
Mailing Address - Country:US
Mailing Address - Phone:970-491-0112
Mailing Address - Fax:970-493-0521
Practice Address - Street 1:2500 E PROSPECT
Practice Address - Street 2:ORTHOPAEDIC CENTER OF THE ROCKIES
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-9718
Practice Address - Country:US
Practice Address - Phone:970-491-0112
Practice Address - Fax:970-493-0521
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO19265207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01192657Medicaid
COC64128Medicare PIN
D23572Medicare UPIN