Healthcare Provider Details

I. General information

NPI: 1184625923
Provider Name (Legal Business Name): JEFFREY F GRANGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 TAYLOR AVE
COLUMBUS OH
43203-1278
US

IV. Provider business mailing address

543 TAYLOR AVE
COLUMBUS OH
43203-1278
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-2663
  • Fax: 614-293-2053
Mailing address:
  • Phone: 614-293-2663
  • Fax: 614-293-2053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01034987A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35091251
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: