Provider Demographics
NPI:1700945342
Name:GRANT, JOHN ANDREW JR (MD)
Entity Type:Individual
Prefix:PROF
First Name:JOHN
Middle Name:ANDREW
Last Name:GRANT
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:JOHN SEALY ANNEX 5.112
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0561
Mailing Address - Country:US
Mailing Address - Phone:409-772-2436
Mailing Address - Fax:409-772-2035
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:JOHN SEALY ANNEX 5.112
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0561
Practice Address - Country:US
Practice Address - Phone:409-772-2436
Practice Address - Fax:409-772-9532
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2014-01-09
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Provider Licenses
StateLicense IDTaxonomies
CO49177207RA0201X
TXE1324207RA0201X, 207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117162102Medicaid
CO67226051Medicaid
TX117162102Medicaid