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NPI Code Detail

MEDICARE: DR. BRIAN J GRANGER D.O.

MEDICARE: DR. BRIAN J GRANGER D.O.
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 PhysicianOS11911FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OS11911OTHERFLSTATE OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366775280
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN J GRANGER D.O.
Provider Business Mailing Address
First Line : PO BOX 746638
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6638
Country : US
Telephone Number : 904-202-2092
Fax Number : 904-376-4075
Provider Business Practice Location Address
First Line : 10240 SAN JOSE BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32257-6203
Country : US
Telephone Number : 904-262-9024
Fax Number : 904-268-9534
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2009
Last Update Date : 11/19/2024

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