Provider Information for 1104143890
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GARY GRANT M. Ed
Sex: Male
NPI: 1104143890
Last Updated: 2024-02-02
Certification Date: 2024-02-02
Certification Date: 2024-02-02
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1104143890 | ||||||||||||
| Enumeration Date | 2010-04-21 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 3830 S CUSHMAN ST FAIRBANKS, AK 99701-7530 United States Phone: 907-452-1575 | Fax: | ||||||||||||
| Primary Practice Address | 4526 FEDERAL AVE # MS 11 EVERETT, WA 98203-2132 United States Phone: 425-349-6200 | Fax: | ||||||||||||
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