MEDICARE: DR. WESLEY DEE GRANGER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	11037	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	800050346	OTHER	MS	UNITED HEALTH CARE
2	800050346	OTHER	MS	MISSISSIPPI HEALTH PARTNE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	800050346	OTHER	MS	FEDERAL TAX ID
5	800050346	OTHER	MS	AETNA

General Provider Information

NPI Number	:	1023030426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WESLEY DEE GRANGER M.D.

Provider Business Mailing Address
First Line	:	11 PROFESSIONAL PKWY
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-4113
Country	:	US
Telephone Number	:	601-856-2460
Fax Number	:	601-856-4687

Provider Business Practice Location Address
First Line	:	11 PROFESSIONAL PKWY
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-4113
Country	:	US
Telephone Number	:	601-856-2460
Fax Number	:	601-856-4687

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	09/24/2019

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