MEDICARE: DR. DEEPA MARIA GRANDON M.D., M.B.A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	46470	AZ
2	207K00000X	Allergy & Immunology Physician	A 112797	CA
3	207KA0200X	Allergy Physician	46470	AZ

General Provider Information

NPI Number	:	1548571623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEEPA MARIA GRANDON M.D., M.B.A

Provider Business Mailing Address
First Line	:	1400 VILLAGE SQUARE BLVD # 3-85340
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1250
Country	:	US
Telephone Number	:	602-905-5155
Fax Number	:	602-654-1847

Provider Business Practice Location Address
First Line	:	2940 E ELEANA LN
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85298-5776
Country	:	US
Telephone Number	:	602-905-5155
Fax Number	:	602-654-1847

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2010
Last Update Date	:	04/15/2026

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