Provider Demographics
NPI:1053802306
Name:CAGLE, GRANT ALEXANDER (MD MPH)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:ALEXANDER
Last Name:CAGLE
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-4741
Mailing Address - Fax:401-444-4445
Practice Address - Street 1:225 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3111
Practice Address - Country:US
Practice Address - Phone:870-207-4100
Practice Address - Fax:870-207-6581
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-18022207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty