Basic Information
Provider Information
NPI: 1467409847
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GRANT
FirstName: TERRI
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 560 GAGE BLVD
Address2: SUITE 203
City: RICHLAND
State: WA
PostalCode: 993528650
CountryCode: US
TelephoneNumber: 5099423627
FaxNumber: 5099422268
Practice Location
Address1: 888 SWIFT BLVD
Address2:  
City: RICHLAND
State: WA
PostalCode: 99352
CountryCode: US
TelephoneNumber: 5099464611
FaxNumber: 5099423115
Other Information
ProviderEnumerationDate: 05/30/2006
LastUpdateDate: 02/12/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XMD00029433WAN Allopathic & Osteopathic PhysiciansEmergency Medicine 
207Q00000XMD00029433WAN Allopathic & Osteopathic PhysiciansFamily Medicine 
207R00000XMD00029433WAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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