MARISSA GRANT (NPI# 1134784796) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134784796 |
| Entity Type | Individual |
| Full Name | MARISSA GRANT |
| Credential | DO |
| Practice Address |
3551 Roger Brooke Dr Jbsa Ft Sam Houston TX 78234-4504 |
| Mailing Address |
1100 Wilford Hall Loop Bldg 4554 Jbsa Lackland TX 78236-5638 |
| Practice Telephone | 2109168666 |
| Mailing Telephone | 2109168666 |
| Mailing Fax Number | 2109168712 |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2020-10-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 0102206367 | VA | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236 | 2109168666 | 2109168712 |
| 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 782344504 | 2109168666 |
| Street Address |
3551 ROGER BROOKE DR |
| City | JBSA FT SAM HOUSTON |
| State | TX |
| Zip Code | 78234-4504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023616398 | Emily M Covais | Student in an Organized Health Care Education/Training Program | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2020-10-09 |
| 1730793191 | George Brett Pulvermacher | Physical Therapist | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2020-09-03 |
| 1053922559 | Aline Noelle Ulloa | Student in an Organized Health Care Education/Training Program | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2020-08-10 |
| 1538778931 | Caroline Elizabeth Conner | Pharmacist | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2020-07-31 |
| 1487263406 | Mary Michelle Ayres | Nurse Practitioner | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2020-07-27 |
| 1265040612 | Suzanne Elise Laux | Nurse Practitioner | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2020-07-21 |
| 1801414677 | James Martin Maloney | Student in an Organized Health Care Education/Training Program | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2020-07-08 |
| 1861019473 | Jonathan Lee Custer | Nurse Anesthetist, Certified Registered | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2020-06-30 |
| 1528685336 | Erin Wheeler | Physical Therapist | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2020-06-26 |
| 1821614322 | Ryan Hyatt | Student in an Organized Health Care Education/Training Program | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2020-06-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255942884 | Thomas Ballas | Student in an Organized Health Care Education/Training Program | 3551 Roger Brooke Drive Jbsa-fort Sam Houston, Department of Behavioral Medicine-mche-dbm, San Antonio, TX 78234 | 2020-08-17 |
| 1124657366 | Wendy Harris | Pharmacist | 3041 Garden Ave, Fort Sam Houston, TX 78234 | 2020-04-08 |
| 1215564729 | Travis Frantz | Student in an Organized Health Care Education/Training Program | 3551 Rodger Brooke Drive, Jbsa Fort Sam Houston, TX 78234 | 2020-03-25 |
| 1508492695 | Matthew Grossmann | Student in an Organized Health Care Education/Training Program | San Antonio Military Medical Center, Mche-zdm-m, Internal Medicine Residency, 3551 Roger Brooke Dr., Jbsa-fort Sam Houston, TX 78234 | 2020-03-20 |
| 1235793407 | Jessica Maria May Franklin | Student in an Organized Health Care Education/Training Program | 3551 Roger Brooke Drive Jbsa Fort Sam Houston, San Antonio, TX 78234 | 2019-04-23 |
| 1730663477 | Glen Snyder | Military Health Care Provider | 3488 Garden Ave Anderson Hall, Fort Sam Houston, San Antonio, TX 78234 | 2018-09-19 |
| 1265919336 | Ashley Elizabeth Malawey | Military Health Care Provider | 3222 Cpl Johnson Road, San Antonio, TX 78234 | 2018-07-23 |
| 1053805515 | Rene Espinosa | Social Worker | San Antonio Medical Center, 3551 Roger Brooke Dr, Jbsa, TX 78234 | 2018-06-19 |
| 1235622333 | Melanie Edith Rivera | Military Health Care Provider | 3600 Roger Brooke Drive, San Antonio, TX 78234 | 2018-06-13 |
| 1063909158 | Benjamin Walker Appelo | General Practice | San Antonio Mil Med Center 3551 Roger Brooke Dr, Mche-zdm-m, San Antonio, TX 78234 | 2018-04-16 |
| Find all providers in zip 78234 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568921583 | Emily Mcdermott | General Practice | 3551 Roger Brooke Dr Dept Mche-qd, Jbsa Ft Sam Houston, TX 78234-4504 | 2019-03-19 |
| 1720645823 | Bradley Bishop | General Practice | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2019-05-23 |
| 1750947552 | Shyam J Patel | General Practice | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2019-05-16 |
| 1184180341 | Matthew Mcclenathan | General Practice | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2019-02-13 |
| 1053804187 | Andrew Ray Jacobson | General Practice | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2018-06-13 |
| 1073006318 | Jeffrey William Moon | General Practice | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2018-06-12 |
| 1841782000 | Dianna Claire Chormanski | General Practice | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2018-06-04 |
| 1841781978 | Courtney Hood | General Practice | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2018-05-24 |
| 1518457688 | Ashley Nicole Soppe | General Practice | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2018-05-15 |
| 1083102420 | Robert Michael Sgrignoli | General Practice | 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 | 2018-05-01 |
| Find all providers in JBSA FT SAM HOUSTON | ||||
| City | JBSA FT SAM HOUSTON |
| Zip Code | 78234 |
Please comment or provide details below to improve the information on MARISSA GRANT.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.