=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043556186
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERICK A GRANA MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2012
-----------------------------------------------------
Last Update Date | 12/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8011 N HIMES AVE STE 2
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33614-2700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-935-1284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8011 N HIMES AVE STE 2
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33614-2700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ERICK A GRANA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 813-935-1284
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number | ME0066670
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------