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NPI Code Detail

MEDICARE: KARL DANIEL GRANROTH PA-C

MEDICARE: KARL DANIEL GRANROTH PA-C
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
1363A00000XPhysician Assistant3602AZ
2363AS0400XSurgical Physician Assistant3602AZ

General Provider Information

NPI Number : 1639294739
Entity Type Code : Individual
Provider Name (Legal Business Name) : KARL DANIEL GRANROTH PA-C
Provider Business Mailing Address
First Line : 2920 N 4TH ST
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-1816
Country : US
Telephone Number : 928-213-6121
Fax Number :
Provider Business Practice Location Address
First Line : 620 LEE ST
Second Line :
City : WINSLOW
State : AZ
Zip : 86047-2435
Country : US
Telephone Number : 928-289-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 03/17/2009

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Directions to “ KARL DANIEL GRANROTH PA-C” Practice Location

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