Provider Demographics
NPI:1730417023
Name:GRANT, ALONZO L III (MD)
Entity type:Individual
Prefix:
First Name:ALONZO
Middle Name:L
Last Name:GRANT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5607 NW 27TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-2826
Mailing Address - Country:US
Mailing Address - Phone:305-805-1700
Mailing Address - Fax:305-805-1715
Practice Address - Street 1:5361 NW 22ND AVE STE 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-8035
Practice Address - Country:US
Practice Address - Phone:305-637-6400
Practice Address - Fax:305-636-5155
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2024-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME122443207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015499100Medicaid
FLME122443OtherMEDICAL LICENSE
FL015499100Medicaid