Provider Demographics
NPI:1649709023
Name:GRANT, MILES W (MD)
Entity type:Individual
Prefix:
First Name:MILES
Middle Name:W
Last Name:GRANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9092 WESTGATE PKWY W
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-2441
Mailing Address - Country:US
Mailing Address - Phone:806-677-7610
Mailing Address - Fax:806-356-0045
Practice Address - Street 1:9092 WESTGATE PKWY W
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-2441
Practice Address - Country:US
Practice Address - Phone:806-677-7610
Practice Address - Fax:806-356-0045
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXU19032084P0800X
MO20170182552086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry