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General NPI Number Information
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NPI Number | 1124128491
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Entity Type | Individual
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Provider Name | ALFRED GRANSON JR. M.D., LLC
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 08/04/2011
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Provider Practice Location Address
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Address Line | 70 MADISON RD
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City | MANSFIELD
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State | OH
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Zip | 44905-2831
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Country | US
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Telephone | 419-589-9700
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Fax | 419-589-2731
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Provider Business Mailing Address
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Address Line | 70 MADISON RD
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City | MANSFIELD
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State | OH
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Zip | 44905-2831
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Country | US
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Telephone | 419-589-9700
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Fax | 419-589-2731
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35072595G
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License Number State | OH
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