Basic Information
| Provider Information | |||||||||
| NPI: | 1346762903 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GRANT D. SHIFFLETT, MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13160 MINDANAO WAY STE 170 | ||||||||
| Address2: | |||||||||
| City: | MARINA DEL REY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902926393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108813688 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13160 MINDANAO WAY STE 300 | ||||||||
| Address2: | |||||||||
| City: | MARINA DEL REY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902926393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105740400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2017 | ||||||||
| LastUpdateDate: | 07/14/2017 | ||||||||
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| AuthorizedOfficialLastName: | SHIFFLETT | ||||||||
| AuthorizedOfficialFirstName: | GRANT | ||||||||
| AuthorizedOfficialMiddleName: | DANIEL | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 3105740400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | A143697 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
No ID Information.