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NPI Code Detail

MEDICARE: LAWRENCE BRETT GRANDY M.D.

MEDICARE: LAWRENCE BRETT GRANDY 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
1207Q00000XFamily Medicine Physician1787621205UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306829056
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAWRENCE BRETT GRANDY M.D.
Provider Business Mailing Address
First Line : 1250 E 3900 S
Second Line : SUITE 260
City : SALT LAKE CITY
State : UT
Zip : 84124-1348
Country : US
Telephone Number : 801-265-2000
Fax Number : 801-265-2008
Provider Business Practice Location Address
First Line : 1250 E 3900 S
Second Line : SUITE 260
City : SALT LAKE CITY
State : UT
Zip : 84124-1348
Country : US
Telephone Number : 801-265-2000
Fax Number : 801-265-2008
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2005
Last Update Date : 10/26/2012

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Directions to “ LAWRENCE BRETT GRANDY M.D.” Practice Location

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