Healthcare Provider Details

I. General information

NPI: 1952345423
Provider Name (Legal Business Name): ERICK ANTONIO GRANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 W HILLSBOROUGH AVE SUITE 100
TAMPA FL
33603-1052
US

IV. Provider business mailing address

2333 W HILLSBOROUGH AVE SUITE 100
TAMPA FL
33603-1052
US

V. Phone/Fax

Practice location:
  • Phone: 813-872-4492
  • Fax: 813-870-1502
Mailing address:
  • Phone: 813-872-4492
  • Fax: 813-870-1502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME66670
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: