Basic Information
Provider Information
NPI: 1982832127
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GRAMMY
FirstName: SEAN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1000 HARNESS DR
Address2: 59
City: SAN RAMON
State: CA
PostalCode: 945832252
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 3901 LONE TREE WAY
Address2:  
City: ANTIOCH
State: CA
PostalCode: 945096200
CountryCode: US
TelephoneNumber: 9257797200
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/25/2009
LastUpdateDate: 07/28/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X20A13122CAY Allopathic & Osteopathic PhysiciansEmergency Medicine 
207R00000X20A13122CAN Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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