EDMUND G GRANT MD PA
Neurology at Bruce B Downs Blvd, Tampa, FL

License number
Florida ME0037350
Category
Neurology
Type
Neurology
Owner
Name: DR. EDMUND GUY GRANT JR. MD
Title: PRESIDENT
Phone: (813) 971-8811
Address
Address
13801 Bruce B Downs Blvd SUITE 401, Tampa, FL 33613
National Provider ID: 1962721761
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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EDMUND G. GRANT, M.D., PA

Tampa, FL

Status:
Inactive
Inactive reason:
NAME CHANGE AMENDMENT
Registration:
Aug 1, 1977
Inactive since:
Jan 26, 1993
Addresses:
13801 Bruce B.downs Blvd, Tampa, FL 33613 (Physical)
13801 Bruce B Downs Blvd, Tampa, FL 33613
State ID:
541596
Business type:
Florida Profit Corporation
President, Treasurer, Secretary:
Edmund G. Grant (President, Treasurer, Secretary), 13801 Bruce B Downs Blvd #401, Tampa, FL 33613 (Physical)
Agent:
Grant Edmund G Md,13801 Bruce Downs Blvd, Tampa, FL 33613 (Physical)
EIN:
59-1761146
Categories:
Physicians & Surgeons

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