MEDICARE: DR. JOHN KENT GRANGER M.D.

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	J6117	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932168069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN KENT GRANGER M.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 51917
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76206
Country	:	US
Telephone Number	:	940-383-2223
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 INTERSTATE 35W
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76207
Country	:	US
Telephone Number	:	940-383-2223
Fax Number	:

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

Provider Enumeration Date	:	03/18/2006
Last Update Date	:	04/25/2018

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