Grant Disick MD PA

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

ME101748 Issued in FL

Legal business name

GRANT DISICK MD PA

Practice address

9970 Central Park Blvd N
Suite 207
Boca Raton, FL 33428-2231

Phone

(561) 487-5506

Fax

(561) 487-9261

NPI assigned

Oct 8, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Grant I Disick, MD

Title

President

Phone

(561) 487-5506

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1286496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294704000000",
    "number": "1427368471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9970 CENTRAL PARK BLVD N",
            "address_2": "SUITE 207",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334282231",
            "telephone_number": "561-487-5506",
            "fax_number": "561-487-9261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9970 CENTRAL PARK BLVD N",
            "address_2": "SUITE 207",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334282231",
            "telephone_number": "561-487-5506",
            "fax_number": "561-487-9261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANT DISICK MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-08",
        "last_updated": "2011-01-11",
        "status": "A",
        "authorized_official_last_name": "DISICK",
        "authorized_official_first_name": "GRANT",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-487-5506",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "FL",
            "license": "ME101748",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "ME101748",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11763982",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrick Vincent Graham, M.D.
• Tiffany E Graham, LCSW, MCAP, QS
• Jessica Erin Granata, DNP, FNP-C, PMHNP-BC
• Jacquelyn Michelle Granda, LMHC, NCC
• Grant a. Killian, PH.D., P.a.
• Sharon Grant-White
• Jeremiah Lewis Grantham, A.P. , LMT
• Ashley Grasso, APRN, FNP-BC
• Liosdany Graveran Valido
• Emily Evans Graves

• Urology Physician in Boca Raton, FL
• Providers in Boca Raton, FL by specialty
• Urology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2011; 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.