Healthcare Provider Details

I. General information

NPI: 1467834150
Provider Name (Legal Business Name): BRANT GRANGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRANT GRANGER

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NE MULTNOMAH ST STE 100
PORTLAND OR
97232-2099
US

IV. Provider business mailing address

100 E 33RD ST SUITE 100
VANCOUVER WA
98663-2776
US

V. Phone/Fax

Practice location:
  • Phone: 800-813-2000
  • Fax:
Mailing address:
  • Phone: 360-514-7560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOL60575247
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: