Provider Demographics
NPI:1700983038
Name:GRANT, MORGAN K (MD)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:K
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 1:4292 W JOSHUA LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILLS
Mailing Address - State:UT
Mailing Address - Zip Code:84062-8056
Mailing Address - Country:US
Mailing Address - Phone:801-358-4663
Mailing Address - Fax:
Practice Address - Street 1:320 RIVER PARK DR STE 125
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6065
Practice Address - Country:US
Practice Address - Phone:801-437-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT267959-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4225OtherHEALTHY U
UT691577OtherDESERET MUTUAL
UTQM0000054865OtherALTIUS
UT107004777101OtherIHC
UT69178OtherPEHP
UT870666269GRAOtherEDUCATORS MUTUAL
UT190683600OtherUS DEPT OF LABOR
UT26795912000001OtherBCBS
UTTPRA08709OtherMOLINA
UT190683600OtherUS DEPT OF LABOR
UTH46448Medicare UPIN
UT005589118Medicare PIN