Provider Demographics
NPI:1861694077
Name:GRAND, ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:GRAND
Suffix:
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 1:1700 ALHAMBRA BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-7050
Mailing Address - Country:US
Mailing Address - Phone:916-731-8040
Mailing Address - Fax:916-454-4152
Practice Address - Street 1:1700 ALHAMBRA BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7050
Practice Address - Country:US
Practice Address - Phone:916-731-8040
Practice Address - Fax:916-454-4152
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093445207W00000X
CAA110469207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1861694077Medicaid
LA07902Medicaid
MI0M92650Medicare PIN