Grant, Bradley P

Grant, Bradley P is an individual health care provider with primary practice located at 1480 S Wickham Rd , West Melbourne FL 32904-2447. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery, Allopathic & Osteopathic Physicians / Procedural Dermatology. Allopathic & Osteopathic Physicians / Dermatology is his primary health care specialty. Grant, Bradley P can be contacted via phone (321) 724-2188.

Contact Information

Primary practice address
1480 S Wickham Rd West Melbourne FL 32904-2447
Phone: (321) 724-2188
Fax: (321) 724-2833
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X ME80040 Florida
Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery 207ND0101X ME80040 Florida
Allopathic & Osteopathic Physicians / Procedural Dermatology 207NS0135X ME80040 Florida

Profile Details

NPI number 1528066073
LBN Legal business name Grant, Bradley P
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 8th, 2005
Last updated Jun 6th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528066073 NPPES
Florida Other 51915 BLUE SHIELD
Florida MEDICAID 261442100 BLUE SHIELD
Florida Other 2120225050101 BLUE SHIELD
Florida Other CIGNA BLUE SHIELD

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