Basic Information
| Provider Information | |||||||||
| NPI: | 1790864395 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORRISON | ||||||||
| FirstName: | GRANT | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2020 28TH ST | ||||||||
| Address2: | SMILEYS FAMILY MEDICINE RESIDENCY | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123330770 | ||||||||
| FaxNumber: | 6123590475 | ||||||||
| Practice Location | |||||||||
| Address1: | 2020 E 28TH ST | ||||||||
| Address2: | SMILEYS FAMILY MEDICINE RESIDENCY | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123330770 | ||||||||
| FaxNumber: | 6123590475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 08/13/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 37465 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | 37465 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 245755500 | 05 | MN | MEDICAID |