Individual provider · Type 1 NPI

Omar Cordell Grant, PA-C

Medical Physician Assistant · Lakewood Ranch, FL

NPI number 1831522374 Active

Practice location

8130 Lakewood Main St Ste 103
Lakewood Ranch, FL 34202-5068

Fax (941) 487-0474

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant 363AM0700XNone listed
Surgical Physician Assistant 363AS0400XNone listed
Medical Physician Assistant Primary 363AM0700XPA9107410 (FL)

Medical Physician Assistant: Definition to come...

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About NPI 1831522374

Omar Cordell Grant, PA-C's National Provider Identifier is 1831522374, issued on Aug 20, 2013. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Lakewood Ranch, FL. The record was last updated on Feb 10, 2025.