Provider Demographics
NPI:1548277726
Name:GRANT, WILLIAM NELSON III (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:NELSON
Last Name:GRANT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 EMERALD BAY DR
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-3779
Mailing Address - Country:US
Mailing Address - Phone:850-533-0166
Mailing Address - Fax:
Practice Address - Street 1:1006 EMERALD BAY DR
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-3779
Practice Address - Country:US
Practice Address - Phone:850-533-0166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7451207R00000X, 207R00000X
OH35-079578207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2257490Medicaid
4054621Medicare PIN
OHB64964Medicare UPIN