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General NPI Number Information
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NPI Number | 1932140456
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Entity Type | Individual
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Provider Name | DALE COURTNEY GRANTHAM MD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 1110 BLUE SAGE RD NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-5763
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Country | US
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Telephone | 509-942-4793
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Fax |
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Provider Business Mailing Address
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Address Line | 3129 N 109TH TER
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City | KANSAS CITY
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State | KS
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Zip | 66109-8901
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Country | US
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Telephone | 509-942-4793
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD00041473
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD2012-0049193
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | MD2012-0049193
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License Number State | NM
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