GRANT W MALLORY (NPI# 1568690477) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568690477 |
| Entity Type | Individual |
| Full Name | GRANT W MALLORY |
| Credential | MD |
| Practice Address |
3551 Roger Brooke Dr Fort Sam Houston TX 78234-4504 |
| Mailing Address |
6401 France Avenue South Edina MN 55435-2104 |
| Practice Telephone | 2109163482 |
| Mailing Telephone | (612) 672-2294 |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2017-09-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207T00000X | Neurological Surgery | 53091 | MN | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | ENROLLED | 05 | |
| IA | ENROLLED | 05 |
| Street Address |
3551 ROGER BROOKE DR |
| City | FORT SAM HOUSTON |
| State | TX |
| Zip Code | 78234-4504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861093338 | Aneesh N/a Benoy | Nurse Practitioner | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-11-02 |
| 1164021580 | William Edward Vick | Pharmacist | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-10-19 |
| 1548868003 | Julia D Coffey | Pharmacist | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-10-15 |
| 1801493465 | Emiri Elliott | Registered Nurse | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-10-07 |
| 1437756574 | Clarence Michael Sullivan | Military Health Care Provider | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-10-01 |
| 1093320350 | Natalie Marie Greene | Physical Therapist | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-09-14 |
| 1033722509 | Kody Vallejo | Pharmacist | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-08-25 |
| 1558972620 | Renee Therese Hart | Nurse Practitioner | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-08-12 |
| 1235749722 | Emily Ann Robinson | Nurse Practitioner | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-08-09 |
| 1902415367 | Hannah Daniel | Pharmacist | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-07-30 |
| 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 | 207T00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neurological Surgery |
| A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356605927 | Ian S. Mcdougall | Neurological Surgery | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2012-06-28 |
| 1922239268 | Ryan Patrick Morton | Neurological Surgery | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2009-08-04 |
| 1407080716 | Ernest Earl Braxton Jr. | Neurological Surgery | 3851 Roger Brooke Dr, Bldg 3600, Fort Sam Houston, TX 78234-4501 | 2009-05-14 |
| 1932112331 | Hans Bakken | Neurological Surgery | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2006-08-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447869003 | Scott B Phillips Pllc | Neurological Surgery | 1303 Mccullough Ave Ste 166, San Antonio, TX 78212-5603 | 2020-07-29 |
| 1710595996 | Laredo Surgical Center | Neurological Surgery | 10410 Medical Loop Bldg 4a, Laredo, TX 78045-6672 | 2020-07-14 |
| 1710506803 | Houston Texas Neurosurgical Institute. Pllc | Neurological Surgery | 925 Gessner Rd Ste 500, Houston, TX 77024-2644 | 2020-04-09 |
| 1760046080 | Adam Franklin Carlton | Neurological Surgery | 301 University Blvd # Mr 0517, Galveston, TX 77555-0517 | 2019-04-23 |
| 1235698911 | South Texas Neurosurgery Associates | Neurological Surgery | 3475 W Alton Gloor Blvd Ste A, Brownsville, TX 78520 | 2019-03-13 |
| 1376009951 | Dallas Center for Neuro and Spine Excellence LLP | Neurological Surgery | 4013 Centenary Ave, Dallas, TX 75225-5430 | 2019-02-19 |
| 1679040414 | Advances Istitute for Joint and Spine Disorders | Neurological Surgery | 6160 Windhaven Pkwy Ste 200, Plano, TX 75093-2138 | 2018-10-30 |
| 1891270989 | Alma Diana Garza | Neurological Surgery | 1139 E Sonterra Blvd Ste 301, San Antonio, TX 78258-4348 | 2018-09-25 |
| 1861975922 | Neurosurgical Group of Texas, LLP | Neurological Surgery | 8731 Katy Fwy Ste 325, Houston, TX 77024-1703 | 2018-09-13 |
| 1508347998 | William T Mccullough Md Pa | Neurological Surgery | 1101 Raintree Cir Ste 12o, Allen, TX 75013-4922 | 2018-08-24 |
| Find all providers with the same taxonomy | ||||
| City | FORT SAM HOUSTON |
| Zip Code | 78234 |
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| 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.