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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1942361951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN K. GRANGER M.D., APMC

Provider Business Mailing Address
First Line	:	201 W GLORIA SWITCH RD
Second Line	:	SUITE I
City	:	LAFAYETTE
State	:	LA
Zip	:	70507-2590
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 W GLORIA SWITCH RD
Second Line	:	SUITE I
City	:	LAFAYETTE
State	:	LA
Zip	:	70507-2590
Country	:	US
Telephone Number	:	337-264-1291
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALLING
Name	:	KRISTY COMEAUX
Credential	:
Telephone Number	:	337-264-1291

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	08/22/2020

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