MEDICARE: BRIAN K . GRANGER, M.D. APMC

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	173000000X	Legal Medicine	022624	LA

General Provider Information

NPI Number	:	1508811449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN K . GRANGER, M.D. APMC

Provider Business Mailing Address
First Line	:	600 E GLORIA SWITCH RD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70507-2512
Country	:	US
Telephone Number	:	337-264-1291
Fax Number	:	337-235-0852

Provider Business Practice Location Address
First Line	:	600 E GLORIA SWITCH RD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70507-2512
Country	:	US
Telephone Number	:	337-264-1291
Fax Number	:	337-235-0852

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	DR. BRIAN K GRANGER
Credential	:	M.D.
Telephone Number	:	337-264-1291

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	08/22/2020

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