Grant Etnyre, M.D.

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

License

36096765 Issued in IL

Practice address

16111 Plummer St
Department of Physical Medicine (117)
North Hills, CA 91343-2036

Phone

(818) 891-7711

Fax

(818) 895-9458

NPI assigned

Jun 30, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dept. of Veterans Affairs

  • Adult Day Care Clinic/Center
  • Sepulveda, CA
  • NPI 1730267576
  NPD (past)
• Porter Ranch Medical Center

  • Contractor
  • Porter Ranch, CA
  • NPI 1184731960
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255360764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16111 PLUMMER ST",
            "address_2": "DEPARTMENT OF PHYSICAL MEDICINE (117)",
            "city": "NORTH HILLS",
            "state": "CA",
            "postal_code": "913432036",
            "telephone_number": "818-891-7711",
            "fax_number": "818-895-9458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16111 PLUMMER ST",
            "address_2": "DEPARTMENT OF PHYSICAL MEDICINE (117)",
            "city": "NORTH HILLS",
            "state": "CA",
            "postal_code": "913432036",
            "telephone_number": "818-891-7711",
            "fax_number": "818-895-9458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETNYRE",
        "first_name": "GRANT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "IL",
            "license": "36096765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Diane Esfandi, DDS
• Eshagh Ezra M.D., Inc.
• Carolyn Espejo
• Geysell Juniet Estrada
• Oscar Armando Estrada, NURSE PRACTITIONER
• Jerome Kennedy Evans Jr.
• Exceptional Medical Staffing LLC
• Eshagh Ezra, M.D.
• Teresa Farag
• Bahareh Farhadmehr, DR

• Pain Medicine (Physical Medicine & Rehabilitation) Physician in North Hills, CA
• Providers in North Hills, CA by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.