Healthcare Provider Details

I. General information

NPI: 1316999865
Provider Name (Legal Business Name): RYAN L GRANDGENETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 DUFF AVE MCFARLAND CLINIC PC
AMES IA
50010-3014
US

IV. Provider business mailing address

PO BOX 3014 MCFARLAND CLINIC PC 1215 DUFF AVE
AMES IA
50010-3014
US

V. Phone/Fax

Practice location:
  • Phone: 515-663-8621
  • Fax: 515-663-8620
Mailing address:
  • Phone: 515-239-4400
  • Fax: 515-239-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number44886020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37407
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: