Healthcare Provider Details

I. General information

NPI: 1972681229
Provider Name (Legal Business Name): DON THOMAS GRANGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 WASHINGTON AVE
EVANSVILLE IN
47714-0541
US

IV. Provider business mailing address

3700 WASHINGTON AVE
EVANSVILLE IN
47714-0541
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number40441
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35062092G
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: