Provider Demographics
NPI:1245120401
Name:GRD LEASING LLC
Entity type:Organization
Organization Name:GRD LEASING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN & OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:DETTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-265-6099
Mailing Address - Street 1:PO BOX 403
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-0403
Mailing Address - Country:US
Mailing Address - Phone:405-265-6099
Mailing Address - Fax:405-338-7455
Practice Address - Street 1:1140 S DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5236
Practice Address - Country:US
Practice Address - Phone:405-733-8000
Practice Address - Fax:405-338-7455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty