Provider Demographics
NPI:1649709023
Name:GRANT, MILES W (MD)
Entity type:Individual
Prefix:
First Name:MILES
Middle Name:W
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 1:8410 W LOOP 335 S
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-7465
Mailing Address - Country:US
Mailing Address - Phone:972-935-3114
Mailing Address - Fax:
Practice Address - Street 1:1901 MEDI PARK DR STE 2058
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2109
Practice Address - Country:US
Practice Address - Phone:806-354-9540
Practice Address - Fax:806-354-9588
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU19032084P0800X
MO20170182552086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry